Mary Claire Haver (on menopause)

Wondery Plus subscribers can listen to Armchair Expert early and ad-free right now. Join Wondery Plus in the Wondery app or on Apple Podcasts. Or you can listen for free wherever you get your podcasts. Welcome, welcome, welcome to Armchair Expert, experts on expert. We are joined today by Dr. Mary Claire Haver. Wow. This is a long time coming. Big time. Armchair has demanded it.

And we have produced it. We actually leaned on Armcherries to tell us who their favorite menopause expert was. Yes. And by unanimous, popular. Dr. Mary Claire. She popped up and she fucking delivered. I love her. I thought she was so great. This is so informative and helpful and needed. And I've brought this up, obviously, to a lot of my female friends. What was the main thing you said? Because I brought it up to some people, too. Oh, I'm just like...

Guys, we had a perimenopause menopause expert on. It's really intense. It's very positive. It's like the most hopeful. It is. It is. I was overwhelmed. Okay. In a way that I needed to be overwhelmed. Just hear everything coming your way. Exactly. There's a lot coming slash here. Yeah. And there are real things to do. And so I got to do them. I've been telling people about the topical vaginal rub. Sure. That's what I was most interested in. Yeah, we learned a lot. We learned a lot. Okay, so.

Dr. Mary is a certified menopause practitioner from the Menopause Society. She is a board certified in abstract and obst- I said this in the episode. It's hard to say. An obstetrics and gynecology specialist and a certified culinary medicine specialist and a best-selling author.

Two of her books, The New Menopause, which is hugely successful, and The Galveston Diet. I urge everyone to follow her on Instagram. She has really, really great videos that will be addressing all these little things that pop up. And also, you could go to her website. ThePawsLife.com, which is a comprehensive approach to menopause education and support. This is awesome. She was rad. Yeah. Yeah. All right. Enjoy. We are supported by Squarespace.

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but for 365 days a year. There's more to imagine when you listen. Listen now on Audible. Subscription required. See audible.co.uk. He's an ultra expert. He's an ultra expert. Lingua Franca? What is it? Lingua Franca? Lingua Franca. So they hosted my book launch, my big New York one of the deals. And she made this for me. Will you wait 39 seconds? Absolutely. This is so nice. I feel left out because I do indeed. Hydro magic. I love it. I'm told it's a...

Wicked reference. It is. Yeah. And the colors are wicked. Yeah. I'm going to a Mardi Gras ball that is Wizard of Oz Wicked themed. In New Orleans? In Galveston. I love Galveston. You've been there?

I have. There's like three people and he's one of them. Yeah. I used to work for General Motors and we had a car show there and our ride route ended there and we stayed at a very cool hotel and each room was like kind of unique. You know the one I'm talking about? So that's going to be the Galvez more than likely. Okay. Very, very nice. On the water. Old. Yeah, very old.

Felt like vampires would stay there. That's it. And you guys moved there. You're from Louisiana. Yeah, I grew up in Louisiana, went to undergrad. I was a raging Cajun, so I quit USL. I'm dating myself. It's now ULL. They're fancy.

And then I did grad school for a little bit, almost went the PhD geology route. Oh, my undergrads in geology. I went to work for an oil company, kind of had a change of heart and was like, what else can I do with the science degree? And I was moving towards the PhD and I'm like,

like, I'm not going to do this PhD. I need to do something cool and big. Let me just take the MCAT and see what happens. So then LSU for med school, which was in Shreveport, North Louisiana. And then I did residency in Galveston and we've stayed in the Houston Galveston area pretty much. Do people tell you you look like Courtney Cox? Yes. Especially back in the day? Yes. When...

She was on Friends. I was a resident and we would have Friends watch parties. And now it's kind of Tina Fey. Anyone with black hair and big glasses is me. Well, both are compliments. Yeah. And we love them both. Yeah, we do. Yeah, huge fan. You're one of eight. Yeah. What did mom and dad do? A lot of sex. Well, clearly, yeah. Good for them. Yeah, yeah. They weren't shy about it. I would walk into the parents making out in the corner. Really? So mom and dad were restaurateurs.

Oh, yes, they owned a Cajun restaurant. Yeah, we just called it food. You would call it Cajun. And it was a little more upscale. It was steaks and seafood. And I grew up in a big restaurant family. My grandparents, my aunts and uncles, most of my siblings. That's why they couldn't keep their hands off themselves, because restaurant people party a lot and they're horny. They party a lot.

It's a whole lifestyle. Lots of naps. Work the lunch shift. Come home. Nap. Nap quotes. How do you choose OBGYN? Yeah, I want to say obstetrician. It's a hard word. I can say obstetrician, but... Obstetrics. Obstetrics. That is tricky. Obstetrics and gynecology. So in your third year in most traditional programs, first two years are just...

in classroom and you get a little taste of different things, but you're mostly just getting the basics down. And your last two years are out in the wards where you're in the hospital rotating and figuring out what you want to do. I remember I thought I wanted to be a pediatrician. I was president of the PEDS interest group, but they called PIG. And I did PEDS.

And I realized quickly, I love babies, but I don't love their parents. The whole dynamic. This is not my niche. Yeah. So then you rotate through surgery. I really like. aspects of surgery, but I didn't like surgeons. Yeah, they're very early. A&T was cool, but super competitive. I had the grades, turns out, but my last block was OB-GYN.

That first night I caught a baby. The block I happened to have first was labor and delivery. I have some awesome upper level resident who's like, we got this. Come on, get in there. And I was like, and I remember calling my mom like, I finally figured out what I want to do. I want to deliver.

I didn't want to have anything to do with menopause. What part do you think was so rewarding? I still could cry. It never gets old being there for a birth. Well, I wanted to dial in on it because two of my favorite experiences on earth are the second both of my daughters. were born, holding them, looking in their face and going, welcome to Earth.

Like there is something so crazy. And I get to see them before you. Yeah. Right, right. And I'm just like, come on. You know, it's never gets old. And it's a miracle. And I make a big production. We lay the baby on mom's tummy and I let the daddy cut the, I let, you know.

He gets to cut the cord and everyone's crying through the whole birth labor process. I'm hanging out. Where'd y'all meet? Let's talk. Cause you don't get that connection in a 15 minute visit through the OB stuff. So I'm there for delivery. I'm not just rolling in to catch the baby. You're also getting to be a part of the most intimate thing that a couple will share.

Or one of them for us, for sure. Like, oh, my God, we made a thing and it's here. As opposed to a meter maid who has to give people bad news all day. This is like the opposite. Yeah. There's occasional bad outcomes and tragedies. And I'm trained for all the crazy stuff that could happen.

time I just get to be there and it's just such a cool experience so that's what I fell in love with and I'm like and I have to do surgery and I have to do this menopause thing and do gynecology but it's a necessary evil to do this baby thing yeah yeah so this menopause thing was a sector of it Yeah. But not even, right? Not even. In medical school, right, we do four years, two years on the books, two years in the wards. And we had one one-hour lecture.

in that first two years. This is menopause. Just a basic overview. One one-hour lecture. I'm not shocked. I know almost nothing. That's why I'm here. I got you. And you pointed out, this isn't my realization, but we're going to do one hour to address. A third of a woman's life. That 100% of women...

Yes. We'll go through. It's not optional. And it's not a couple weeks or a couple months. It's a third of their life we're going to just not worry about. Yeah. But, you know, it wasn't put to me that way. This is just a transition and estrogen declines and off you go. And she might have some. hot flashes. We've got medicine for that. Okay. Then in OB-GYN residency, which is women's health, probably 55, 60% of what we did was to do with OB, getting people pregnant.

Staying pregnant, unpregnating them, all the trials and tribulations, important stuff. So proud of everything I learned. And then everything else gets shoved in the box of gynecology. And we have... reproductive endocrinology, which is basically endocrine stuff that happens, weird chromosomal things, and...

getting people pregnant for fertility issues. We have pediatric gynecology, how to take care of smaller people with the same organs who have issues and need help. We have general gynecologies, well-woman exams. So menopause was part of our REI block.

reproductive endocrinology, which we only did second year for six weeks. We had a one hour lecture each week. So I got six hours. So in eight years of medical training and education, I had seven hours of menopause. We had no menopause clinics. And then I was leashed onto the...

world, go be free and practice. I didn't know anything. Yeah. You've come to regret how many women were basically asking for your help. And in that paradigm, you pretty much were just turning people over to different specialists. I didn't know enough. At the time, to know that her palpitations, her frozen shoulder, her, you know, myriad. Frozen shoulder? Oh, girl, wait, we're going to get there. My mom.

Oh, no. Laundry list of complaints. I'm the well woman examiner and I got 15 minutes to get through this. So I'm like, we're going to send you to cardiology for your palpitations. We're going to go to the ortho for your shoulder. So I'm giving her six referrals. Sleep specialist for your insomnia. Yeah.

And a nutritionist for your weight gain. And we're good. Your pap is normal. See you next year. And then you yourself started going through menopause. I was, you know, I had an endocrine condition. I didn't ovulate regularly. Why? I had fertility treatment. for my kids. You had PCOS? PCOS. I had the two pay kids, finally got that done. I don't want to go through another miscarriage. We're done. So I go on birth control pills to manage my condition, which I did great on. That was fine for me.

And then I get to about 48 and I'm like, okay, I think we're getting close to where we're going to be. And I'm totally suppressing my period. So I'm not taking the inactive pill. So I'm totally replaced all my hormones and shut it down. I felt better that way.

PCOS. I was like, probably time to get off see where we're at so I talked to my nurse practitioner who took care of me and was like I'm gonna get off the pill we're gonna get some blood work in a month and see where I'm at she's like cool very same time my brother dies so I have six brothers from the same parents my oldest brother died when I was nine

from leukemia. So I was a kid when that happened. And then my next brother, Bob, had HIV and hepatitis. The HIV is actually really under control, but it was his liver just tanking, tanking, tanking. So I've stopped the pill, see where Mary Claire's at, and I'm in the OR. The phone's ringing, ringing, ringing. I'm like, get the phone.

And they put it to my ear and they're like, Bob's in a coma. You probably should start heading home. Did you know that was coming? Eventually. I'd sat the kids down and said, you know, Uncle Bob's getting sicker, but not like today. It kind of was abrupt despite knowing it was coming. Yeah, I thought.

wait a year, two years. Anyway, my partner comes down, we get to a good part in the case, scrubs me out and I go and prepare to go home and figure all this out. So here I am grieving this horrible thing and... I am in full on menopause, but I don't know it. I'm gaslighting myself. I'm attributing all the things to grief. And certainly grief was a part of it. But after like month six, I realized the grief is lifting. I'm not crying all the time on the way home. I'm like...

When was your last period? Shit. It must be so comforting to hear an OB be out to lunch on their own house. Yes. I didn't like menopause. I was like, ew. I was like Samantha on Sex and the City. Not the menopause. And so I was like, Dora, I'm going to come get the blood work.

now. And so we did everything. And sure enough, I was fully, fully menopausal. And that's detectable. Yeah. Check your estrogen, check something called FSH. One's high, one's low. That's it. So it's all in the blood work. Yeah. Perimenopause, no. We don't have blood work for that. Okay, that's what I was going to ask because I think I'm in it. I know. Everyone your age does. I looked up all the stats for Southeast Asia. Oh, you did? Yes, I did. Thank you. Yeah, so we'll go over that.

I reluctantly go on hormone therapy because I'm like, I cannot live like this. I was still in the impression I would get breast cancer and die. It was going to kill me. Well, let's address that right now because I happen to know way more about this than I should because I love... Women. Well, I do love women. But Dr. Atiyah, I love Peter Atiyah. And he's been such a vocal supporter of this. But so all of this, the hysteria that you probably received was based on...

The work of two people virtually. So the WHI study was a large multi-center trial. It was one of the biggest projects the NIH had ever taken on. And for the first time. They were studying women. We were so fucking happy. We knew from anecdotal evidence that women who were on HRT before the WHI. And that's hormone replacement therapy. Sorry, hormone replacement therapy. 40% of women were utilizing HRT and menopause. So that was kind of the base.

baseline rate. It was recommended by the American College of Physicians. I mean, it was like, everybody should consider this. We knew that women who chose it had lower heart disease, had lower certain risks, but that's not proof. That's an observational study. So if you follow a TIA, you need a randomized controlled...

So NIH, billion-dollar study. Let's study women. They got 37,000 women recruited. Half were placebo versus estrogen or estrogen and progesterone if they had a uterus. Which is a huge issue already right there. Right. If you're not combining the two.

The particular estrogen that they were on was Primarin, which we don't use today very often. And then a very specific progesterone. It wasn't using modern HRT formulations. It was just looking at this one. But at the time, in the 2000s, that was the most common formula.

used. Nothing weird there. Because they were looking for heart disease as the outcome, is this really protective for heart disease or are just wealthier, healthier women on HRT and we're getting an artifact? The average age was 63 in the study. A little late. We know it works for hot...

flashes. We know it'll take care of menopause symptoms, but does it really help with heart disease? So they wanted to start later because it's expensive to go 20 years. So if we start later, then we'll start seeing the heart attacks in a quicker timeframe. They did have younger and they had some women in their seventies start. to 79 off they go with the trial the women on estrogen only had a 30 decreased risk of breast cancer

And that was statistically significant. The women on the combo saw a slight increased risk, but it never reached statistical significance. Really quick, the reason it was kind of irrelevant statistically is that the control group...

had an abnormally low rate. That's it. Which was not even considered. So when you compare the two groups, whoa, this is really causing. It was four guys. Chlebowski, Aragowski. I can't even pronounce their names. Yeah, they're rough names. And they still stand by it. It's crazy. Just recently, they're back at it. There were 17 centers involved in the study. There were multiple PIs, primary investigators. And these two or three guys wrote this paper.

And said, estrogen causes breast cancer. HRT causes breast cancer. And they called everybody in the room and said, take a look at it. You have one hour to make changes. They rejected all the changes. And then they went to the press. There's no pair with you. Yeah. No. They just said it. And it was like.

letting a genie out of a bottle. Flawed interpretation and hysteria. There was no viral for internet back then, but it was the number one medical news story of 2002. It was on the cover of every magazine. Nancy Snyderman is on ABC saying, don't give anyone estrogen. I was a chief resident. I remember the day it came out and we were like, what?

I was terrified to give people HRT. What I didn't know in the ensuing 20 years, being board certified, getting my recertification every year, reading every article they put in front of me, I was the straight A student. They never walked it back to the OB-GYNs. And the guidelines... have not been changed in American College of Ob. Jones since 2014, and they still say,

Only for severe symptoms. Smallest amount for the shortest time possible. Wow. And in pre-study, it was at 40%, which you said. And then last year in 2023, we just got this published in the Menopause Society. It was 4%. 4%? Wow. 4% of women who are eligible. are receiving FDA approved. Now, there's probably more with compounded. It's hard to track that because they don't report. So maybe seven, but still.

There's a great bit of context around this. So you start having the symptoms. You decide you want to do some investigation in this. In your investigation, you quickly find out. If you were to search medical peer-reviewed articles and journal entries about pregnancy.

Almost 1.2 million. And if you look at menopause at that same period, 94,000 articles written. Do you know how much brain power we're talking about? How much NIH funding, how much private funding, how many labs? That's 10 to 1. And more women will go through menopause than bare children. Exactly. Yes, and the bearing children process will last them however long you want to say that window is. Average of two kids, nine months each. 30 years? No. So pretty nuts. And maybe now's a fun time.

Because I actually want you to explain menopause, but I think now would be a fun time to just talk about men versus women here. Yeah. Because my father, at the same time that's being published about HRT for women, my dad is being advised to be on testosterone because his level is low and it improves his life.

It goes off of antidepressant. It's fine. So men have a slow decline from like 18 or 19 down till they die. But for most, it's still detectable. Now, you might function it better at a higher level and no one's going to deny that to you. It would be. As if.

Your testicles shriveled up and died at the average age of 51. And your empty ball sack is flapping in the breeze for the next 30 years. And we're not going to do anything about that. Good luck to you, dude. Yeah, exactly. We're never horny again. So here's a sleeping pill. Here's something to improve.

your libido, maybe. Here's a palpitation medicine. Here's an antidepressant. Yeah, it's just like get through the rest of your life. They're talking about over-medicalizing menopause. The critics, and I'm like... Bitch. Yeah. I'm giving her six drugs or I can wipe the whole thing out with just replacing her estrogen that's gone missing. Right. And it'll actually increase her bone density. It'll actually have real results. It is the longevity drug for.

females. Nothing's going to work better than that. Wow. So, I mean, there's a lot in there. Now, you can raw dog menaboss. No one's making you go on it. You can't underestimate the layers of sexism that exist within the fact that it would take however many years before we would acknowledge, oh yeah, women are really suffering from this. And they have a bunch of symptoms from a bunch of different...

issues arising from this and better to treat those than to get to the core of what's going on. When you look at why menopause hormone therapy was developed, it was to treat a hot flash and forever the pathognomonic, the poster child symptom.

was hot flashes, what we call medicine vasomotor symptoms. What was never taught to me ever, and I learned like three years ago, was we have estrogen receptors in every single organ system in this body. And what I also was taught is in perimenopause, it's a slow... decline. That's all I learned. One sentence. Decline until full menopause when you lose function. It is a rocking roller coaster.

And your worst symptoms tend to be the mental challenges, the brain fog, the cognitive disorders, the frozen shoulder. All of it is Perry and early. That's when you're accelerating your loss of bone and muscle and the eggs. Right. We were born with.

all of our eggs. A million, though. That was a shocker to me. So one to two million at birth. One to two million eggs. But isn't this weird? It's like that thing where you're born with all your eggs, so really your grandma's eggs are your eggs. Yes. When you're...

grandmother was pregnant with your mother. The egg that made you was inside of your mother, inside of your grandmother. In some ways, women have always existed. So there's all this knowledge, wisdom, and trauma that they think that this imprinting that goes on through.

a traumatic pregnancy. Okay, a million to two million eggs. We lose eggs two ways. One, and from the minute they form, we start losing it through atresia, which is like an aging process. And it's kind of survival of the fittest because not all eggs are good eggs that you want to fertilize.

So we want to leave the healthy ones behind to catch the sperm. So atresia is happening. Boom, boom, boom. And it accelerates at 35. We see a big drop off. And then just from ovulating, we lose about 10,000 to get one to like pop off. Every ovulation cycle. Every ovulation. Is that...

in your menstrual discharge? Where are all those eggs? They just kind of dissolve. So when one egg pops out, the fallopian tube picks it up and it gets swept like a chimney through the fallopian tube and it's fertilized or not in the fallopian tube and then it goes into the uterine cavity and some... Sometimes they can pick it up in the minutes, you know, when they've done studies, but sometimes it just kind of.

But it's tiny, tiny microscopic. Yeah. I wrote it down. By the time you're... 30, you're down to 10%. Down to 10%. How old are you now? 37. Okay, so at 40, most women... And this is different for you, and I'm going to explain why. Don't shoot the messenger. are down to 3%. This is for people who look like me. This is the average American white girl. Are you Indian or Southeast Asian? Okay. Average age of menopause is 46.5. For me, it is 51. Okay.

So that's average. The window 41 is still normal for an Indian descent. And then that goes up to 51. You start younger and then perimenopause back it up seven to 10 years before that. Am I in it? Maybe.

I bet you have a mix of emotions, validation and depression. No, I don't want... Yeah, this one is not good to be validated. I don't... Oh, God. Okay. Well, how would I know? That's a great question. Certainly if your cycles were starting to become irregular and if you had hot flashes, if you had the kind of...

symptoms, but those are usually late in the game in perimenopause. I don't have that. The most common symptoms, actually, now that these online telemedicine companies have developed for menopause and they are doing scoring systems on hundreds of thousands of women because everybody goes to their website, amiamenopause.com. And we have all these quizzes and things you can take. Fatigue.

Out of the ordinary. Nothing has changed. Your diet hasn't changed. Your stresses haven't changed. New onset mental health changes. We have a 40% increase in depression and anxiety across the menopause transition with no real environmental changes. We have weight gain. It's a steady state weight gain. But what's happening in the background with body composition is we have this acceleration of muscle mass loss and an acceleration of body fat gain.

typically in the viscera. So the intra-abdominal fat. So my patients used to come in and grab their tummies and their little paper gowns and be like, what the fuck is this? Mary Claire, I worked in a small town and we all went to church together. What is this? I knew her. I worked out with her. We ran together. I know this woman. I know what she eats.

that's when i was like why are all my friends and now me gaining weight in weird places none of us have gone off the deep end we're not secretly eating bonbons at night yeah and then bone density is another key thing so we're seeing

Acceleration of bone loss. And so I'm telling my patients, let's get early bone densities. Let's not wait till 65. Yeah. Especially if you're programmed to go through younger than what's expected. Okay. Can you get pregnant? You absolutely can get pregnant. During perimenopause. It's just a little harder. Your supply and the quality of the egg goes down, which you knew. You know, the older you are. She's frozen some eggs. I have. I've done two rounds, but it.

Wasn't great. There's already been some telling. But it is still regular periods. But as you said, maybe that's the later end of it. Towards the end of Perry, I mean, you're getting close to exhausting the whole deal. Combativeness with coworkers. Oh, my God. That's so healthy.

Perfect to who you're working with. Brain fog. You know, suddenly you lose your words. We all do it from time to time, but this is consistent. Get in the car and you're like, where am I going? You walk into a room. What was I doing here? You know, everybody does that from time to time. Okay, we should have done this at the beginning. beginning, but now I'm going to make you do it now. We're unique.

As an animal. There's a pod of certain whales that do it and elephants are very matriarchal. But when you look at like the anthropologists and they're like, why do women go through menopause? So from a survival standpoint, it behooves a woman to not keep being pregnant over and over again. You kind of have your back.

And then you have better survival rates if you stop. The anthropologists also think that women served as the source of wisdom for the tribe. They were the passers-on of knowledge. The dudes tended to die younger because they're getting killed.

by saber-toothed tigers. The grandma stayed back. Now remember, these people were still very young compared to when we think of a grandmother now. We also died a lot sooner. Things that don't take people out now like vaccines and childhood diseases. We have a reason why we live longer. You're right. There was a...

very predictable role for the grandma she was passing on all this wisdom helping with children now we have all these things we have child care and we farm things out to strangers and this whole role that once served our genetic fitness. We've industrialized our way out of it. We've evolved past our genetics. Yes. So we're saying the reason that human women didn't die is because of their... Well, those who kind of ran the gaunt...

of disease and being killed by accidents. If they survive, they seem to take on these very wisdom creating, teaching the next generation. You know, if you look at whales, they're teaching the babies to hunt while the moms are hunting, gathering with the dads. Or grandma elephants.

very involved in the ant system. And I guess, too, would I be wrong to say this? I'm assuming childbirth gets more dangerous as you're older. Yeah, it's harder to do and it's harder to stay healthy doing it. In general, we would lose more women to cardiovascular.

issues, hypertension, preeclampsia, that kind of stuff. Before modern medicine, we had medications to help manage those conditions, diabetes. So that's how we got there. We're kind of unique. As you say, there are a couple of other people, but let's talk about...

What physically happens during menopause? Let's talk about the endocrine system. What is it? What does it do? And how does it change? So let's talk about what you're going through right now. In a healthy woman who has a regular menstrual cycle, nothing has ever stayed. state. It's an EKG like ebb and flow of some key hormones and ovulation starts in the brain.

not in the ovary. In order to ovulate, the brain registers that our estrogen level is low. So you have your period, your estrogen, progesterone, drop off. The brain gets that signal. Whoa, we're low. The hypothalamus is testing. It says, all right, it's time.

sends a signal to the pituitary, next gland underneath. And pituitary is like, all right, boss, I got it. The pituitary then sends LH and FSH. So if you've done any fertility treatments or, you know, these words or had the shots, you know, I did all that too. So those two hormones go down and bind.

to the ovaries to stimulate the ovulation. Around each egg are a set of cells, follicular and granulosa cells, and then produce our sex hormones. Estrogen in the first half of the cycle, which peaks at ovulation. After ovulation, we see progesterone rise. And that cycle... is unbelievable and goes month after month after month in purpose.

Infection, unless you're ill or you're pregnant. Crazy athlete. There are things that we can do to mess it up. But for the average woman, the cave woman, this worked very well month after month after month. And is testosterone going up in preparation? That's the one steady state that we have. It might mildly fluctuate, but really testosterone starts high in our 20s and 30s and then just like a man. It seems it would be...

It's evolutionarily advantageous if it upped your testosterone when you were fertile. When you're ovulating, but we just don't really see that. Female-male drives are a little bit different. So then what happens in perimenopause, in the background, we're losing eggs, losing eggs, losing eggs.

reach a critical egg threshold level which is different for every human where the signals coming from the brain no longer work. We become resistant because the quality and the quantity of the cells around the eggs available are declining. So the brain's like, where is my estrogen? The pituitary is like, boss, I sent the signal. He's like, send more. You start pounding the ovary with the GnRH to the pituitary. Pituitary is like, fuck, all right.

Shoots out FSH and LH. We see the stimulating hormones start to rise much higher than they ever, ever were in a pre-menopausal woman. Just trying to kickstart this system. Right, and just kick it in the ass. So we see delayed ovulation, so the period starts to become irregular. And then because you were just... pounding that egg, we end up with higher estradiol levels than we ever had before.

That's why twins are a little bit more common towards the end of your fertility. Oh, interesting. Yeah, than they were when you were younger because you're getting your self-made fertility drugs basically. Right, right, right. To push that egg out. And then progesterone never quite gets to where it was before.

So what used to look like this gorgeous EKG each month now is literally a zone of chaos. Interesting. So you have estrogen doing this, progesterone's like, I'm trying to keep up. FSH and LH are all over the place. And that's why we don't have a great... blood test for perimenopause. I can't do a one-time blood test and say, obviously. Now for post, when you run out of eggs, FSH and LH, the brain is always looking, always pushing, always trying. And now we know.

We have FSH receptors in other areas of our body. We think the bone. We know the liver. So sometimes it's not just the loss of estrogen, but it's these high FSH levels that are leading to the cholesterol changes that we see. A new study just, just, just came out two weeks ago that was looking at using a specific cholesterol marker, LDL marker called... super dense LDL as a marker for perimenopause. Like we don't have a good blood test, but would AMH be helpful, which is one of the fertility.

things that we check, which is an ovarian reserve hormone. Would you have needed a baseline test prior to any of this to be relevant? So that's a great question. People ask me all the time, okay, so if I'm going to replace my hormones in my menopausal journey, would it have been good for me to know in my 30s where they were? I'm like, where in the month?

Would you like me to check? Probably not the high because that's when we have the breast tenderness and we worry about stimulating the uterine lining too much. Right. So one of the problems with menopause treatment is we've just titrated to get rid of hot flashes. But now we know. Women absorb very differently and not everyone's therapeutic on our transdermal doses. So in my clinic, we're starting to check three months out.

What are her levels? How is she absorbing? We know that women who start HRT in the first 10 years have a 50% per year lower risk of a new heart attack, cardiovascular disease, atherosclerosis. It's very protective of the endothelium. What we don't know is what were those levels? We just know she was on it or she wasn't. Right. Yeah. So should we be taking estrogen during perimenopause? I think so.

Yeah, there's quite a big group of data. We can decrease your risk, but it's just how. Do we suppress and replace like what's in a birth control pill? Or do we just support, give you just enough to calm the brain down and make your symptoms better, but allow the process to proceed in the background? Right. There's tons of debate in my... world about what's better. Stay tuned for more Armchair Expert, if you dare.

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Getting serious about your own reluctance to go through this, which is a great motivator. How do you approach it? What do you start looking at? How do you even begin assembling what becomes the toolkit? I wish that I could tell you, you could confidently walk into your OBGYN.

your family medicine, your internal medicine doctor, and have a reasonable, logical conversation about your plan of care in perimenopause and menopause. That is not possible right now. It is not the fault of the individual doctor. They may have been... excellent in your birth and your pregnancy, every aspect. But because of the six hours, so right now they surveyed residents coming out three years ago.

Only 30% felt barely adequately trained to treat menopause. It's awful. So at least they're honest. Call ahead. Look on the Menopause Society website, which is menopause.org, and see who has passed the test and is certified there. It's not perfect.

There's always people out there who aren't great doctors who took the test, but it's somewhere to start. We crowdsourced with my followers. I've got thousands of testimonials and we organize them by country, city and state to help people. They don't pay me just to go find a provider who might be able to help you.

And right now it's pretty slick. There's some great telemedicine companies that have been developed, mostly female founded, who saw a gap in care and they saw a need and they developed these telemedicine companies. I have women calling me from New York, LA. London, the most well-connected you would think who have the same basic questions and the same worries and the same fears and cannot find help as the woman sitting on the couch in Iowa. Yeah. Okay. So as you start.

focusing on it and kind of pledging to get competent in it and start treating women. Are you yourself even shocked with the amount of symptoms? Because I wrote down symptoms and it's about the longest list of symptoms I've ever written. I was shocked and most of that was driven by questions I got on social. As my little social media plot. When 10,000 women ask you about frozen shoulder or palpitations or vertigo, you're like, they can't all be lying.

Then I'm digging and I'm like, somebody who did the study, there's clear data here. So I go online and I make a little video talking about the correlation between menopause and vertigo, menopause and foot and shoulder, menopause and palpitations, and the world goes crazy. I get 10,000 comments. Why didn't my doctor know? Again. We're doing a terrible job of teaching, but I was literally learning alongside my followers.

Right. As I learned, I'd make a video and teach. And that's what inspired me to write the book. And they were like, please write a book. I don't want to chase you all over social media. It's too complicated. Just put it all in one place. Frozen children, that is scaring me. My mom had it. My grandmother had it.

One of my mother-in-laws has been dealing with it for the last six months. So this is a great story, and I hope I get the lore right. But the story goes, the first study on frozen shoulder and menopause, and it came out of Duke University, I read the paper.

And it was the head of OB-GYN and the head of orthopedics who both happened to be women. And it was something like they were sitting in the doctor's lounge or in the cafeteria and just shooting the breeze over. Can you believe all these women with frozen shoulder? there's a correlation. I don't know. Let's look into it. They started pulling charts and they were like, fuck me. Look at this. Women who are on HRT have a lower incidence of frozen shoulder and they do better.

They're getting it, but they're getting it less than women who aren't, and they're having a better course. So they go to get it published. They go to orthopedic journals first. Nobody would touch it. Nope, this can't be right. Nope, this is an artifact. Nope, nope, nope, nope. So one of the menopause journals published it. And so then I have a friend, Vonda Wright, she's an orthopedic surgeon. She does a ton of teaching and she wrote the paper on the musculoskeletal syndrome.

of menopause. How does that all work? Estrogen receptors and probably progesterone here as well are all over the musculoskeletal system. We know bones. We got bones down. We've known about osteoporosis since I was a resident. I know that one really well. But what wasn't understood was tendons, muscles. and the connections between bones and muscles and how that all works together.

Frozen shoulder is adhesive capsulitis. There's a capsule around the ball joint and the shoulder that gets absolutely adhesed and frozen. And it's an inflammatory condition. You can't put your arm behind. You go to take a picture. Yeah. And it's very, very painful. You need early intervention. You need physical therapy. There's needling. They have to break it up and that we can delay the onset.

And the duration and probably prevent several cases for women on HRT. Because estrogen is protective, so it's an anti-inflammatory. But my mom, I've never heard her once say she had that because of...

Menopause. Well, no, most women don't know. Most orthopedic surgeons don't know. We're working to change that. That paper was written a year and a half ago. Oh, wow. Okay, so ringing in the ears? Yeah, tinnitus, tinnitus. I still don't know how to say it correctly. Yeah, I had it for a minute and I...

Didn't know what to tell people. I've had it once and man. People kill themselves from it. Maddening. Yeah. So again, this is an estrogen receptor problem. The vertigo is that the crystals break off. quicker is basically osteoporosis in the ear. And the crystals break off and then float around and you're dizzy. But the tinnitus, the inflammation around the nerve and around some of the auricular bones that they feel like is leading to a neck. All these studies say...

Age-matched women, premenopausal women definitely have it less than post. And women in HRT are less likely to get it. Yeah, wow. What are some others? Dry skin. Yeah, in the skin and tegumentary. Skin and the hair follicles. I like tegumentary. I've never heard that word. That's nice. All the follicles and oil and sweat glands. It's the whole system. Largest organ in the body. It is. Most absorbent. So we lose 30% of our collagen. You don't have to tell a woman that. She knows. In the first...

five years of menopause, we can attenuate that with topical or systemic hormone therapy. Topical works better actually, which is why I'm on my vanity cream. Is it a retinol? No, it's estrogen for the face. Wow. So it's compounded. Some people take the vaginal product and we'll mix it in their moisturizer and put some on their face. But you should talk to a doctor before you do. You shouldn't do that on your own. Don't do any compounding at home. So yeah. Mix it up. Yeah. A little mortar.

and pestle, you lose oil production in the skin, you lose thinness, and the trans epidermal water loss is much greater. So you're just... losing all your barrier, your protection. So the skin is less healthy. Dry mouth, that's the same. Dry mouth, same thing. So mucus production, the salivary glands dry up. We have tremendous dry mouth. And dry eyes, dry mouth is the same. Guys, I don't want... This is fucking miserable. Body odor. What's creating body odor?

Early in menopause, as the estrogen levels decline, something that's made in the liver called steroid hormone binding globulin, SHBG, which binds our sex hormones and carries them around the blood and renders them inactive until they... let loose and then they bind to go do things when we lose the binding hormone the activity of our androgens increases even though your total testosterone may not be different but the free is higher so when i first got a panel for testosterone

My overall numbers were like fine, not alarming. My free was super low. Your SHVG was high. Yeah, I had the binding globulin. Yeah, so you had some, but they were bound and you couldn't use them. That's right.

It's a balance because you can eat certain things, take certain things, certain supplements to increase, decrease. But then sometimes you're robbing Peter to pay Paul. And so in women, when the activity of their antigen increases, we see male pattern baldness. They start getting chin hair and their odor changes. They smell like onions and it's a really kind of weird. Yeah, I hear the onion thing a lot. This is so awful. Monica.

I am living my best life. You just stick with me. Okay. So I like to hear that because my mom actually said the same thing. I don't think she did any hormone therapy, but I was like, when did you hit menopause? She said 50. And I was like, oh man, well, I'm nervous. I'm in. perimenopause after I read this book and she was like,

Well, I like it. I smell like onions. My mouth is dry and I'm happy as a clam. I don't want to scare people. So many women just go blindly into the night and they have no idea. And so one of my critics have said, you're just fearful.

mongering, you want to scare people, whatever. I'm like, no, I want to educate so you're not blindsided. You imagine the cortisol levels that will come down where they're like, oh, this is what's going on. This might be my menopause. Fine, whatever. Okay, we got this. I'm not going crazy, especially the cognitive changes in the mental health. The divorce rates, the suicide rates are all right in there at this age. They kind of peak there. Peak suicide rates are 45 to 55 in women.

Wow. And that should be the kind of transition in life where you're like, oh, I made it. I made it. I'm going to lean into work. We're going to go off in the sunset here. No. Wow. That's heartbreaking. And is that hormonal too? The neurotransmitters in the brain. are heavily influenced by estrogen, progesterone levels, and the brain doesn't like the chaos. So the real mental health that we see, the big, big problems are in Perry.

Post, things tend to calm down, both cognitively and mental health. You still may need your, you know, whatever, but we see this wild uptick in Perry. So decreased sex drive. I think this is also something that... People have just taken for granted. I learned.

This much about sex drive. She's holding up a zero for the listener. Holding up a zero. Sorry. I get my little diploma and I graduate. Now I'm at the top of my class. I won lots of awards and off we go. I'm going to go be the best OB-GYN. So the pregnant people come and then these other people come. I'm like. Ew. So like as you're walking out from the Well Woman exam, I'm like, okay, we'll see you next year. She's like, can I ask you one more thing? Sure.

I have low libido. I don't want to have sex. It's really affecting my marriage. And I was just like, deer in the headlights. You're like, I don't know. You're old. That's probably what you're thinking. Hold, please. So I go out in the hallway and I find my boss, who's our mentors when we first get out, keep us out of trouble.

in those first couple years. I'm like, hey, so Ms. Smith, everything's fine. She's healthy, but there's sex. I can't even say it. I'm deep South and taboo. He's like, oh, tell her to have some wine. She just needs to relax.

and it'll be fine. Just pat her on the knee, but she's going to be okay. Tell her to anesthetize herself so she can get through it. Exactly. Women just go through this at this age. So many people were complaining over and over again. I started looking for resources, and I read...

Venus and Mars in the bedroom. Like that was my Bible. That was the only thing I knew how to do. No one taught me. I was going back in my textbooks. Nothing was talking about sexual desire drive. I didn't even know all the causes of female sexual dysfunction. It was never a lecture. No one ever talked about it. Here I am. am the expert going, I'll be right back.

Let me see what I can find. So I ended up making little handouts for my patients on what I could dig up on desire and herbs. And I didn't know about, well, they came out later, but Addy and Vileci and testosterone and all these things that might be helpful to a woman and counseling and therapy and looking.

for orgasmic disorders and arousal disorders and pain disorders and pelvic floor dysfunction. Because it's common for sex to get more painful, right? When we go through the menopause transition, 100% of us are going to lose the... protective effect of estrogen in the vagina, the vulva, the bladder, that whole what we now call the genital urinary system, pubic bone all the way back and up to the bladder. We lose elasticity.

we lose the ability to produce mucus. So if you biopsy to pre and post-menopausal vagina, pre-menopausal, it's this thick, velvety, full of mucus glands, very resilient. It'll take a beating and be fine. Baby comes through there. It's traumatic, but they'll make it. And then... Post-menopausal looks like a desert. You went from this gorgeous, thick, multi-layered tissue to six cells laying on top of each other with no mucus, no nothing like a desert.

All we have to do for those women is give them back estrogen in the vagina, and all that tissue will grow back, even at 70. You can absolutely prevent and reverse this condition. So I recommend lubricants for all of my patients on every section.

encounter. Just get used to it. Do it proactively. Normalize this. And then I'm advising not to wait until you start having symptoms to use vaginal estrogen. It's very safe. It's like skincare. It doesn't absorb much. There's very much risk-free if you have active breast cancer. you can still use it. It will save your life. I mean, it prevents UTIs. The best treatment for recurrent UTIs for a menopausal person is vaginal estrogen, not recurrent antibiotics. And it's just topical. Yeah.

They have creams, gels. They have a suppository. They have a ring. There's multiple ways. But generic and cheap, the cream works for most people. Yeah. Wow. Where's testosterone in the drive part? So when we look at female sexual function, we have five buckets. She may not be happy. First of all, it has to bother her. Some women are like, I don't care. I'm never going to care. And I'm like, okay.

Then you're going to do you. Other women are like, I used to have it. I miss it. So you have to make sure she's not having pain. There's a pain disorder. She's not having a relationship disorder because no amount of testosterone is going to fix a bad relationship. Does she have an orgasm or is the plumbing still working if she puts her mind to it? Does that drop off?

You see arousal disorders, it's more of a blood flow issue. I kind of had that. I was having delayed orgasm. Like, hello, everything's working. I'm ready. I was like, okay, fine. I need vaginal estrogen now. And it took about eight years of menopause because I was on systemic, but I wasn't quite getting enough and everything. is fixed. Libido, which is desire. In medical, we say hypoactive sexual desire disorder, HSDD. That is a mood. It's totally in the brain.

Everything's working down here, but it's the thought of it. And most women will come to say, once we get going, I'm fine. So if a female has an arousal disorder, vaginal Viagra might work for her. What does that do? Increases blood flow, vasodilator, specifically to the corpus. spongiosum. So that's the squishy part that gets erect. We have exactly the same tissue in the clitoris. Well, your clitoris becomes my penis. Same anatomy, except ours looks like Gumby and yours is like a little rocket.

So we've ruled out all the things and she's like, I love him. I'm not going anywhere. I miss it. Please help me. So we have two classes of meds that we talk about. One is testosterone. It works great for these women.

If it doesn't help her in three months, that's not the answer. And the options for testosterone are? So we don't have FDA approved option for women. So we're either having someone cook it up in a lab and get a compounded cream generally. So right there, red flag. Ridiculous, right? Ridiculous. We have studies that...

Improve the safety and efficacy and all the things. And she's so much happier. There is anecdotal evidence that also her stamina is better. Her mood is better. Muscle mass goes up. Muscle mass. And then decreases osteoporosis. So all that works together.

So I don't want to say it's a chandelier. So I have low muscle mass genetically, and I'm doing the things, eating the protein, working out as a full-time job, wearing my weighted vest. And I was like, what if I tried some testosterone off-label for myself, did not have a libido issue, and no one was complaining. And then... Start some testosterone. And I see an uptick in the area. A little more interested. He's not cuter. He's not pissing me off less. He's not my poor husband. But I'm just like.

okay, a little more often, or maybe I'm even initiating, which had not happened in a long time. And we've just reached a different level now. And I think I would miss it if it was gone. So I'm like telling my patients this. Certainly if you're distressed, let's go for it. But here's my...

My experience. So that's a topical. You don't want to do oral. There's no form available in the U.S. that will not affect the liver. There's one they use in Australia and I can know it, but it's not available here. So you're going to look at a non-oral option. So some people are doing some. compounded injectables. What we're doing in our clinic is either T-STEM

gel or androgel. So we're doing the FDA approved gels for men. We're just using them off label for women. Interesting. You can also get a capsule. So there's trochees that dissolve that are submucosal. So you put them under your tongue. Oh, you mean the pellet. The pellet. Pellets are commercially available. They're not FDA approved. There's a problem with pellets that we see kind of in the ethical realm. Two problems with pellets. If you go to a doctor...

And they are trying to talk you into pellets and they won't discuss any other form of hormone therapy. That is an ethical red flag because they are financially... benefiting from the sale of the pellets. And I just think you can do better because pellets are very hard to manage. You have this rapid rise and I've seen females with testosterone levels in the four and five hundreds and I am not kidding.

They never made a female level pellet. They just give females the low level and say, you're running 200, you're fine. You're not going to die. They don't slowly dissolve at a predictable rate. They're supposed to. I've never seen a decay curve. Have you? They don't publish them. They're not FDA approved, so they don't have the same regulation.

So I'm like, listen, we don't need to be doing this. And I can take it away tomorrow. If you have a pellet, you are stuck until it's gone. Three months generally? Generally. I think we can do better for our patients. I don't...

need to make money putting pellets in people. It's a cash cow for a lot of practices. I'm just really hesitant. If your doctor is really railroading you, if they say I only do pellets, I would probably bounce. Interesting. Okay. Good tip. Okay. So back to, so we can do an injection.

Injectable. Injectable. You can do a cream. You just rub it. You'll get really hairy wherever you rub it, but that's fine. You could, so I'll tell patients to put it here. Oh, I was teasing. Is that real? There's no hair follicles here. I was studied on the shoulders. Okay. We want to monitor that.

to see how they're absorbing, make sure we're not going over, checking their free and total testosterone levels and just seeing how they're doing. I'll say I started on a cream. The only thing I didn't love about the cream is you have this dispensary for it and you click the amount that comes.

out per click per day did not seem very consistent to me. It seemed a little all over the map. I much prefer just an injection. You know exactly what you're getting. Another option to think about would be to do the T-Stim gel or the Androgel. It's in a pump. So a full pump is 20 grams.

For women, we need five to 10 grams. So that's like a half pump or a pea-sized amount. I tell my patients to put it on their inner arm where there's no hair follicles so they can see the pea. And then you just rub it in. Wow. Okay, so you're doing testosterone on your arm. Estrogen on your vulva. What else? I think I replaced my hormones like five ways. Yeah. For estrogen, there's oral and non-oral.

And in non-oral, patches are what we usually prescribe in my clinic. On your Instagram, you're a fan of those, right? They're very inexpensive. We have multiple strains, so I have a lot of options for patients. But sometimes people have a reaction to the adhesive, tape allergies. So we have gels and cream.

It's just the expense goes up. The vaginal ring is great because you get two for one. You get systemic and vaginal. But they're like $200, $300. They last for three months. It's nice. You just throw it up there and forget about it. Toss it in. Yeah, I get scared of that. Yeah, it's not for everyone. Even like the divas.

cup. It's not for me. You don't want something in there. Yeah, I don't. You have an outsized fear of toxic shock syndrome. I wouldn't say outsized. I have a real fear of it. As you should. Yeah, it's scary and you die. And then there's local estrogen options for the face and or the vagina.

And then your progesterone. So progesterone is typically given in the menopause. We're giving oral micronized progesterone. It's the safest. I believe I understand a lot about testosterone and estrogen and estradiol, but I don't know that I know a ton about progesterone. What is it doing?

So progesterone is mandatory if you have a uterus, if you're doing estrogen, because the inside lining of the uterus, the endometrium where the blood would be made each month, is sensitive to estrogen. If we let estrogen play in there and opposed with progesterone, you'll develop hyperplasia.

potentially malignancy. This is where some of those studies were misleading because that was in the early, early days of hormone therapy and the like, get your wife back, sexy movement with estrogen. They were doing just estrogen and women were getting into metrial cancer. So we learned that lesson. You give her a progesterone.

you will negate that. So if she has a uterus without the Mirena IUD, which has progesterone in it, you must give progesterone to not potentially give her cancer. Turns out progesterone is amazing for sleep. It upregulates GABA in the brain, and it is our sleep, sleep hormone. So when patients are coming in in early perimenopause, still having regular cycles, but they can't sleep, they're waking up at 2 or 3 in the morning, progesterone might be your new best friend.

It's fine to start with progesterone without estrogen. We do that in a lot of cases. I have so many things to take. You need a hormone doctor immediately. I do. I do. I need you. It's great for that 2 a.m. wake up. I'll just take an extra one if I still have that.

have a hard time just falling asleep. I mean, it's worth the trial. It's not going to hurt you. It's a natural problem. And none of this is a problem with getting pregnant. If you're in perimenopause, your chances of getting pregnant are lower. But if you are...

trying to spontaneously get pregnant, you have to make sure you're giving low enough doses where you're not going to inhibit a standard ovulation. And menopause hormone therapy really was not high enough to suppress ovulation. So the biggest difference between birth control pills and menopause hormone therapy.

You think about why they were created. Birth control was formed for contraception. We need a high enough dose to shut the signal down from the hypothalamus, to tell the hypothalamus, we're cool, we got enough estrogen, no signals.

No signals, no ovulation. Menopause hormone therapy was developed to simply stop a hot flash. You don't need nearly as much. Got it. So it's lower. Formulation, though, is different because of big pharma. Formulation tends to be ethanol estradiol, which is cheap and easy to make. hundred times as potent as estradiol. And that's why you have those little tiny birth control pills. Whereas...

So estradiol in its natural form, which is body identical, it's much less potent than its cousin, ethanol estradiol, but it's got a great safety profile and you don't need much to stop the hot flash. Now, how much do we need to prevent cardiovascular disease? You don't need much to help your bones. did study those numbers. So we're all kind of debating if we're going to check levels, what's therapeutic? Okay, wow. Okay, so...

We really covered HRT, hormone replacement therapy. I'm so glad you're an advocate for it. I think it's insane that women have been just left out of this. What I have experienced being on hormone therapy, which has made me want to work again, made me want to do my... How many doctors did you go to? A woman on average has to go to six to eight doctors before her menopause is diagnosed. This is how bad the problem is. Well, I'll be clear. The general practitioners tend to still be pretty...

Adverse across the board in my experience. But we have hormone clinics on every 10 feet for men. Most of them don't see women. So all one needs to do is go there. You actually need to police them, I think, is my tip. Yeah, and that's kind of the palate. It's the bio team.

really that got into, well, let's put these in women and see what happens. And you don't need to be at 1100. Yeah, I know. I mean, these women are coming in. They're like, I don't know why my hair is falling out of beard. And I took her level and it's 450. I'm like.

I might have a clue. Because women, what, naturally in their 30s would hover around what? So around 40 to 70-ish. Yeah, so that's a good 8X. Yeah, so, you know, most of them come in in menopause 12, 15, 20, 25. Let's get you up. So I'm trying to titrate my... patients 60 to 70. Let's overshoot just a little bit and see if this is going to help with your libido. But there are two FDA approved medications for libido that are not testosterone.

One is Vilesi, and it is an injection you give yourself 45 minutes before, and it causes a massive dump of melanocortin that then stimulates dopamine.

And when our dopamine levels are higher, it makes us want to do things. Yeah. So, unfortunately, most of my patients don't... choose that because they're like there's a praying mantis on the other end of this waiting the 45 minutes going is it working well additionally it's almost the wrong medicine for the arousal type that women are which is like that's great for a man because a man's sitting around thinking

about wanting to fuck in an hour. And he's like, oh yeah, I'll do this. Whereas a woman needs to be brought into arousal. Right, it's not very romantic. Exactly, yeah. So it's almost like a counterintuitive solution. For the women who like it and can unlock that part of their brain, it's great.

Is it a base dopamine? Like, don't give it to an addict. I've not seen those studies. I've not had a patient yet who was like, yes, please. Addy is another. So Addy was studied in mood and they saw an uptick. Tell us how Addy works.

So Addy works, same thing. It's going to increase your dopamine levels. And it's something you take every day. We studied in mood. It works by increasing happy sexual encounters a couple of more times a month or however they measure it. So the detractors of Addy are like, well.

that's not enough. And the women are okay with it. Right. Right, right, right. If you were having nine or one, go into four. That's enormous. I'm like, let the patients decide. Most of my patients choose testosterone purely because of cost and potentially the other benefits for bone and muscle, even though we don't have great studies yet, but the anecdotal data is looking very positive in that area.

Right. So if you just kind of reverse engineer, as I understand, or if you believe a Tia and I do, the best way to combat osteoporosis is to not get osteoporosis. Well, yeah, that'd be great. Is to not get it. But your bones respond immediately. to muscle and strain. So if you can work out heavy, you're putting a lot of strain on your bones and they will react. They will make themselves stronger. And for you to do a lot of strenuous and high intensity heavy

lifting, you're going to benefit from testosterone with your muscles. They're all related. The musculoskeletal unit works together. It's not like it works in isolation. So testosterone will help a little bit. We looked at one of the things from WHI when the women's in health.

Health Initiative is they followed these women forever and they followed them into nursing homes and they looked at protein intake and frailty scores. And the women who ate the most protein, like 1.6 grams for every kilogram of lean body mass, had much lower frailty scores.

I'm drilling down. We're going to prevent your osteoporosis. We're going to consider hormone therapy and estrogen. We know we'll prevent 50% of fractures. Yeah. So she's on HRT. We're going to work out heavy. We're going to lift heavy and we're going to eat the protein. We're going to get some creatine on board. So all of that work.

works synergistically. I call it my nursing home prevention program because once I put out the fire for menopause and she's functional and she's your mom and me. Now we're like, I don't want to be my mom. My mother is in a nursing home with Alzheimer's and a broken hip. She just got out of rehab. She's not doing well. Right.

It's going to take a long time. And all of these four horsemen are metabolic disorders. Alzheimer's is not the natural course of an aging brain. There's 14 risk factors. So, of course, the easy stuff. Don't smoke. Eat a balanced diet. Stay away.

from processed foods, don't get diabetes, don't get insulin resistance, all of that. But then it's social connection. Keep your brain moving, thinking, working, do the puzzles. When my dad died, mama had lost Bob in 2015, one of my brothers, my second birth from esophageal.

cancer. The third one, they lost the one when he was 18. When I was nine, she'd lost two kids and a husband in five years. And she was like, I'm out. She locked herself in the house and started drinking, which I can't blame her. What I've seen it do to her, the relationships with her kids. And this long protracted course she's going to have until she goes. And all the talking of the children on how to manage and who's doing what. I don't want that.

Exactly. You know, I want to die like my dad. He was great until like the last month. And then he kind of slowed down. And then we all gather around and we sang songs and told stories and were there and sang to him and he slipped into a coma and then it was over. Yeah, that sounds great. That's not what happens. women. We have this nursing home. She's frail and she breaks. Alzheimer's. Yeah. Boy, that's so true for my grandparents. The men just...

collapsed. Yeah. And the women just struggled for five years and got crankier and more miserable. My patients are not interested in option B. Yeah. Okay, so we have diet and I'm glad you're collecting protein. Top nutrition tips for

aging and longevity for women and menopause is she limiting added sugars so the whole keto movement sugars got demonized but it turns out that sugars added to stuff are much worse than found naturally in fruits and vegetables because the sugar in a fruit is wrapped in a fruit

Which has fiber and vitamins and minerals. And this is a doctor who sells supplements. But I think everyone should be able to get everything they need from food. That just doesn't happen. That would be amazing if it happened. That's ideal. So I'm here to help you fill in the gaps where you need it. Fiber, vitamin D.

80% of my patients are deficient in vitamin D. We're checking everyone's levels. We're telling them to supplement. I'm giving prescription doses if they're super low. We're trying to give them loading doses. Magnesium is really great for a lot of patients. I have a specific collagen product that was studied in menopausal.

osteoporosis that seems to have some benefit. So we're talking about that. For movement, most of my patients are walking minimum. You have to meet her where she is. Is she sedentary? Just walking 30 minutes a day will decrease her risk of diabetes by 50%. That's it. If she's walking, let's put on a weighted vest. If she's doing that, let's get in the gym. You have to meet them where they are. All the influencers, they're lifting and all that. I'm like, that scares the shit out of most women.

It seems insurmountable. So we're easing them into it. I love to run these challenges for my followers. We'll get 100,000 people who are lifting weights for the first time and I'll have a fitness person in there. I didn't know either. I was injuring myself. Of all the ologies, you didn't do kinesiology. Kinesiology is not.

on my list. So I will hire someone to come in and show my followers how to do a squat. You don't have to do a lot of different exercises, just the really basic push, pull. There's some real key ones that are super beneficial, particularly for osteoporosis.

Squats, lunges. For osteoporosis, good studies with walking with a weighted vest, doing yoga with a weighted vest, balance training with a weighted vest is super helpful. Fibratory plates, again, you're stimulating that musculoskeletal unit. I tell patients to brush their teeth on one foot.

because you're working on balance to always be decreasing your risk of fall with balance training. And then lifting, they were putting 80-year-old ladies in the gym from nursing homes and they were seeing all these gains. And grip strength's a big indicator. So grip strength is a proxy for the rest of your body. Right.

If you do deadlifts, you will inadvertently get... Yeah, so it's not the grip strength. That's an easy thing to measure. That's an indicator. I got it. That's an indicator. Stay tuned for more Armchair Expert, if you dare. Let's talk about something that might be keeping you up at night. Cybersecurity. According to Vanta's latest state of trust report, it's the number one concern for UK businesses. That's where Vanta comes in. Whether you're a startup,

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So that's exercise, diet. Now, where do GLP-1s fit into this? We do use them in our clinic and probably 20% of our patients end up on them. When they come to us, it's usually, hi, I'm in menopause, help me, I'm dying. Probably 50 to 60% of them now have a weight problem. have either always had it or they have new weight gain. So the first thing we do is break down

where their fat is. If they have it, because some patients come in, they're just muscular and they've been told they're obese their whole life and they're crying their eyes out because, oh my God, I'm healthy. What? If they have a visceral fat problem, I really don't care about subcutaneous fat. It's not...

metabolically that active. It's just storage. It's the intra-abdominal fat that'll kill you. And so we are working on that number. And what do we know works for that? Starvation, but that's not why they're there. High fiber diets, low added sugar, diets rich in probiotics or a probiotic supplement. Zone 2 training, all of that works. So we're focusing on that and we get our start in HRT.

Across the menopause transition, a woman will go from 8% of her total body fat being visceral to 23 on average, just from becoming menopausal. No changes in diet and exercise. I have the unusual circumstance of most of these people follow me, have read the book.

It's an investment to come and see me because I'm outside of the insurance model. Yeah. So they've done their homework. They're dedicated. Yeah. So they're like, okay, let's do this. We start HRT. We bring them back in three months. If her cardiometabolic risk factors are still there and she's like, I want to give it.

a try. I'm like, let's go for it. A GOP-1 needs a lot of counseling to be done well. Yeah, because you're taking on a lot of risk of muscle mass loss, which is so important for your hospital. Although there's supposed to be a new one coming out. Yeah, that's...

Three. So there's semaglutide, which had just the GLP-1, and then terzepatide, which is what we usually start with now, which has the GLP-1 and the glucagon agonist. And then this new one has, I forget what the third ingredient is, but I'm excited to see when it comes out. Yeah, it's supposed to reduce.

the loss of muscle mass in our clinic if the patients eat the protein and do the resistance training we are seeing some muscle loss expected but not this massive loss and they are able to maintain and then it's like that first three months

If they lose 20 pounds, maybe five is muscle, maybe 20%. But then that just levels out and it's all fat loss after that. It is absolutely the coolest thing to watch because we bring them back every six weeks to check their muscle mass. We stay on top of it. We're checking. with them they're doing this not to look great in a bikini I mean maybe that'll happen and that'll be great but they're doing this to

decrease their risk of all these diseases they don't want to die from. Yeah. Or plague their children with. Protect the last 15 years of their life or 10 years of their life. And be happy during those. They're so motivated to avoid the diseases that plague their elders. As you might expect, my wife, knowing that I was interviewing you, had some specific questions. Fire away. Are there any ways to predict when onset will be?

Kristen heard your mother's sister can be a guide. There is a genetic component. So there's an ethnic genetic component. So I was telling Monica for me, it's 51 is average for her. It's 46.7. African-Americans is about 18 months behind Caucasian. Asians get a little bit longer. Okay.

Does sexual activity impact that? Trauma does. So we know lots of things that speed it up. You were born with X amount of eggs and they're going to go before you die if you live a normal lifespan. But what do we know speeds up the process of egg loss? Smoking, chemotherapy, radiation.

abdominal surgery, you have a hysterectomy, leave the ovaries behind, but we've cut a significant blood supply to the ovary. We're going to lose average of four years off the life of the ovary. A lot of women undergoing necessary hysterectomy aren't getting that counseling. There's nothing they can do about it, but wouldn't that be nice?

to know? Yeah, I have a friend's friend who had to have a hysterectomy. She's like, I'm about to be in menopause. My mom had one when she was 30. My mom had one after baby number eight. They were like, this is your Catholic birth control. Time for that uterus to come out. So does it instigate menopause? It cuts the blood flow. So you lose...

The shelf life of the ovary where you may have gone through a 51, now you back that up four years on average. Okay. But it's not like you have the hysterectomy and then you start. No, unless they remove the ovary, right? Exactly. So that's surgical menopause and we have premature menopause and early menopause. So those are.

are a little bit different animals. Premature ovarian insufficiency is usually with an autoimmune condition, so it has its own set of risks. And in surgical menopause, you don't get a trial period. It's like boom.

So whenever I had to take out ovaries for medical reasons, I was putting a patch on them in the OR. Yeah, that makes sense. Okay, so ethnic is a predictor. So ethnic and then family history. You look at the women in your family, when did they go through it? But on your mom's side, is she right?

Mom's side and sometimes dad's side. I mean, you're half genetically. She compared it to male pattern baldness, which we know comes from your mom. But I was saying, well, that's because it's on the 45th chromosome and you can only get an extra mom. So this isn't a chromosome only thing. Yeah, so it's not like that, right? It's more of a general health thing.

how things are going to go. Certain tribes in Africa have a lot of twins or certain cultures are more prone to twins. That's more of a general than a chromosome thing. There's a couple things happening. A, it was completely understudied, as you pointed out. It's beginning to get studied, but also we're seeing an art. What do you think about the impact of all fours? I'm literally on 79% of the chapter.

First of all, I hate the protagonist. Okay. Yeah. So she's not my girl. Yeah. But I'm researching and writing the new perimenopause. It's not coming out till 2026. I'm in the middle of it. And so Gretchen, who's my co-writer, I write like an asshole. I am so clinical.

My collaborator will take my disgusting prose and spin it into something that sounds digestible, like a human. Not a normal person could read, not geek. And Gretchen's like, read it from the perspective, this is resonating. And that just flipped the switch for me. I read for an-

I read about fairies and dragons and lots of sex. And my daughter reads all the dystopian novels. So I read to read with her and talk about stuff. And then I read medical journal articles. So to pick up a book that is outside of my usual and not have a 15 year old little girl who turns into a princess with magical powers. It's like hard. I'm trying to identify this. She says, stop trying to identify. Read it and figure out why the hell the world is resonating. And then I'm like, oh.

So then the doctor in me is like, she's having palpitations. That's a panic attack. That's menopause. That's menopause. That's menopause. Now, have an affair and redo this room in this weird hotel. That's a whole nother thing, but I'm getting it now. It is so hard resonating.

Movie rights are done. Oh, yeah. All my friends read it. Did you love it? I loved it. I haven't read it. I've been told what it's about from Monica, who loved it. To me, it's like I was prescribed a role I don't want or I want to test or I want to shake up or I want to break because.

I just prescribed it and now I want to decide. I don't want it anymore. That's so perfectly paralleled to, hey, guess what? I don't want to live a third of my life in discomfort. That. So what I'm finding, and I think why the divorce rate's so high, is that women, and myself included,

And thank God my relationship is better than it's ever been. And we're working together. We have a small business through the supplement company and he's now running it. I've never liked him more. But yeah, she's getting to choose the last third of her life. And so did I. I chose differently than her.

That's okay. But women are circling the wagons around themselves. Menopause is fucking them so hard. They are giving themselves permission to put themselves first. Yes. To me, it's I've had enough on all the levels. And now it's a survival thing. If I don't do this. For me, my journey was.

Quit a job that didn't serve me. Stop serving a system that was broken. Absolutely get the hell out of Dodge. Figure out what the fuck I wanted to do with my life. Put my own oxygen mask on first. It's time for you. And I really didn't give a shit if the kids or my husband cared. But I had to do this. Thank God. It all worked out. And look where I am now. But that's what it is. It's I'm making choices for the first time that are for me that aren't just handed societally to you. But.

What's scary about that book is now is the time I get to make the choices and my body is disintegrating. That's the part that I think everyone was like, oh my God, we have to wait till then. And it's coinciding with that. What do we do? How do we prevent? ourselves from getting to the too late part, right? Too late to celebrate. Well...

Educate yourself as soon as possible. That's part of my mission is just vomiting all over social media. I think a lot of people think of HRT as being what you do after you have all the symptoms. That's the next wave I think is preventative. Where?

Some of the hardcore old school menopause people are like, don't say prevent. They come after me every time I talk. Look, FDA approved for the prevention of osteoporosis and that is enough for me. But let me tell you, the U.S. Preventative Services Tax Force needs to get their shit together because. you have a window of opportunity for cardiovascular disease prevention and the data coming out clearly for mental health.

We can prevent the suicides, the job loss, the brain fog, unless you're on the dementia spectrum, with early and judicious hormone therapy, not allowing your body to withdraw and go through that chaos. Yeah, why wait till you have all the symptoms? It's crazy. Why wait till your vagina's...

But there's no other condition that we don't think early detection and treatment is beneficial. It's never been thought of like that. It's way too you're miserable. And then it was severe symptoms only. A doctor's going to tell me if my symptoms are severe.

What does that even mean? What does that even mean? And why? It's like some old vestigial Protestant suffering something. Women have been taught to minimalize. Did you read the WW story? Oh, yeah. Whiny women. The whiny woman. It's just what women... go through. They tend to whine a lot. Early in her residency, they'd come to her and say, we got a WW in room 305. The woman with a laundry list of complaints, very vague, weight gain, brain fog, low libido.

And they're like, check her thyroid. Get these tests. Make sure you're not missing anything, but you're not going to be able to help her. It's just a whiny woman. It's just one of those whiny women. So I talked to other doctors across the country. And in California, they called it whiny gynies. Oh, nice. And on the East Coast, around New York.

York, it was TBD, Total Body Dolores. And in Miami, it was Madame Dolores. Oh my God. What is that? Pain. Oh, okay. She's got a lot of pain. Women who come in and complain a lot, kind of vague. Libido, go have some wine. You'll be okay. Yeah, yeah, yeah. Oh my gosh. This is wild. I don't want to scare people. But when did you know? No, it's good to know. We don't know anything. And your doctor, not their fault, may not know.

Yeah. None of us know. Even the smart people who are educated. I do these girls dinners and we just had one recently and we were talking about something random. We were like, why don't we know the answers to any of these questions that keep popping up about our own bodies?

Yeah, because it was never studied. Women in medicine have been treated as small men, so excluded from studies till 94 because of thalidomide and what happened. If there's a chance in hell she might be pregnant, we need to exclude her. And oh, we probably shouldn't study them anyway because hormones are hard.

Yeah. They didn't even study female rats in the lab. Oh, really? Because they have estrus. They too. So they too will fuck up your study. It'll be confusing. The cardiovascular data is awful. for women. You go into the ER with a heart attack. If you're a woman, you have a 50% higher chance of dying.

than if you're a man because we have atypical chest pain. So men have the classic clutching their chest, going up their neck, sliding down their arm. You're an actor and they're like, pretend you're having a heart attack. I know exactly what you're going to do. A woman has fatigue. abdominal pain. It's very vague because...

Men have the LAD, the widow maker, the very large vessels that immediately come out of the aorta to dive into the heart muscle to feed that heart. That's where the plaques happen. Women, it's way down below that. It's the diffuse microvascular disease. You're always shoving it down. So another way to speed up your menopause is trauma.

So there was a study that looked at women who were sexually abused who then had kids who went on to be sexually abused, and they went through menopause nine years sooner. Wow. My mom must have hit menopause at like 35 because she had a hysterectomy. She got the trauma, then the kids with trauma. Her libido is OK. That somehow is well.

I think it's trauma related, but yeah. That's true. There's a million factors. Your book's a bestseller, The New Menopause. You have the Mary Claire Wellness Clinic. It's my little baby clinic in Galveston. You have...

Many millions of followers that are interested in this subject. You were the person people wanted to come on the most. Yeah, we turned it over to America and said, who's your favorite menopause expert? And you were voted on. You were elected. And we were like, who do you want to come on experts? And your name came up over and over and over.

It's a different audience. But is it? It's all women. I don't know. We have a lot of women. Just people need to know. People don't know anything. Well, I appreciate being on here. And actually, my kids now think I'm cool. Oh, wonderful. Two daughters? Two daughters, 21 and 24.

Okay, cool. Are they on? Oh, that's a question. How early can someone get on these things? Well, it's a little early for them. So Catherine's in med school. She's tough, man. She has guaranteed me she's not doing OBGYN. But talk about having... Having someone hold a mirror up to you and keep you in line and double check your facts behind your back. So I'm like spitting out studies and she is literally.

Looking it up to make sure I am toe in the line. She's talked about it. She's a little freaked out and wants to freeze her eggs now for the highest quality. I think that's the move. I kind of do too. So I did a talk. I was at Reese's event, Hello Sunshine. I was the emcee for the first time. That was fun. Of a panel.

One of the panelists started this where you go and you donate your eggs, but you get to keep some. Oh. So it's a way for the younger women with these juicy, gorgeous eggs to afford. Oh, it gets paid for by the. Right. That's nice. I love that. She gets to keep a few for herself.

Oh, I like the little for you, little for me. I'm a terrible host because I forgot the name of the company, but, you know, it was so cool. And so I went home and told Catherine about it because she's starting to think about that kind of stuff. I love that. I'll be whispering that.

That's my girls. Oh, yeah. Then the time clocked off. I have a friend in Telluride who gifted his daughter with egg retrieval. Yes. Again, I didn't even know about this. I didn't even know about egg freezing, really. Like, you kind of hear about it. And then my best friend works it.

Netflix, they pay for that. And so she was like, oh, I'm getting this done. That's a covered benefit. That's amazing. It's amazing. I mean, it's smart for them too. They have someone in the prime of their career who doesn't want to necessarily take the time at that moment. It's so smart. But I was like, why are you doing that? She was like, well, they're paying for it and you might as well. And I was like, interesting. So then that's when I started thinking about it. But my.

Age person did not think about it at all. Did you just do it? I did it at 35. Okay. And then 30. six it's ubiquitous and common knowledge to go like at 35 you're officially in a geriatric they act like you fall off a cliff and all that but it is a steady state it's steady but I did better the second time weirdly amazing but I wish I had known so much earlier

and just done it and felt insurance. My 21-year-old is not on the radar. She's just trying not to be pregnant and is living her best life. That's the problem. That girl gets to college. My oldest is by the book, straight A's, pre-med.

I'm like, go to the party. Have fun. Come on. I'm like so worried about her social life. My second one has rolled with 20 kids her whole life. She gets there within October. She's like, I'm out of money. Like she went with her summer money and her graduation money. I'm like, what? I check her account. I'm like, bars.

Beards, clothes, fast food. I go, you have a meal ticket. She goes, I don't like it. So I'm like, you're out of money. You still have an allowance. I'm not going to let you starve. But she went and got a job and now she's a nanny. Oh, that's great. The funniest stories.

It's her taking care of other people's kids. These Baton Rouge moms. That will definitely not get her to freeze her eggs nannying. I will say that. She's not at all worried. Yeah. To any young people, I just really encourage it. I think a lot of people...

Get a ton out of your book. It's wonderful. The new menopause book. And please follow you. What's your handle on Instagram? Dr. Mary Claire. D-R-M-A-R-Y-C-L-A-I-R-E. You're very cute in your videos. I watched a hundred of them today and they're so cute.

makeup. She's in her weight test all the time. I brought glam with me and I'm like, no one's going to recognize me. Who is this girl? Oh my God, that's so great. And you're doing all these fun things. You mentioned Reese. I know you're doing something tomorrow that's very cool. Love it. We're grateful for you. Thank you. the women I know are so grateful for you big time yeah so everybody read the book follow you on Instagram this was awesome thank you thank you so much we finally got you

Stay tuned for the fact check. It's where the party's at. Hi. Hello. Cute jacket. Oh, thank you. Instagram Impulse Spy. Really? Got one in this color and one in blue. From where? Marine Layer. We like Marine Layer. Yeah. That's a place. That's a thing. We are sweatshirts. We're from Marine Layer for a little while. Yeah, I like this quilted thing. Yeah, quilted is nice. That's what we call it. Well, what one's quilted for comfort? The toilet tissue.

Oh, Charmin. Charmin. The quilted quicker. Well, that's a paper towel, right? Yeah, that's a paper towel. The quicker picker. This is a Mandela effect we've created. Wow. People are like. Do you think there's a product called Charmin's Quilted the Quicker Picker Upper? People would say yes, definitely. Because it's bounty.

Bounty, the quicker picker upper. But the bounty doesn't have the same alliteration as Charmin and quicker. Charmin, quicker picker upper. How was your morning? My morning was good. Every two weeks, I get a flower delivery on Friday from Flamingo Estate. Okay.

And it's really exciting. It is. You've signed up for a biweekly annual sitch. Yeah. Do they spice it up? Is it a different bouquet every time? Yes. So you don't know what you're going to get. So you have anticipation. What will it look like? Yes. And it's always from a cool like farm. They find a guy who just has one flower bed in his backyard. Extra, extra small micro business. Today it was ranunculas. And their orange flower. Oh, that's the name of something.

Ranunculus. And they're orange and they're so pretty. I did lose a little track of time because I was cutting the ends and I was, you know, cleaning up the stems. Yeah. Easter egg, we just learned a fascinating fact from somebody. It's a rule in sketch comedy. It's not our rule. Yeah. But if a man comes in to pick a woman up on a date in a sketch, have him bring chocolates, not flowers. So if you bring flowers, the audience starts getting very distracted.

They got to put them in a vase. Oh, my gosh. She's got to get those in a vase. Got to give them in water. And you can't even pay attention. I know. It's so smart. These delivery services. Yeah. They can really brighten your day. I would recommend that for a gift. Yeah, that sounds like a good gift. Yeah. Unfortunately, I did try to gift this exact thing today. Oh, just today. Today's Callie's birthday. Oh, happy birthday, Callie. Happy birthday, Callie. And I was going to get her.

this weekly bloom bundle. Right. The gift that keeps on giving. Yeah, but it's sold out. Oh, all right. So I can't. That's the problem when you go with these micro growers that only have one flower bed in their backyard. Yeah, they run out. Yeah, it's a really great idea, but then in practice. It's part of the fun. It's part of the limited dish element.

Okay, so I don't want to say this, and I just really can't control myself to not say it. Okay. Because I got to get out of the habit of addressing. Yeah, I would prefer not. I know. That's why I don't look at them. Yeah, yeah. But I just want to make this simple point because people, you know, Jonathan Haidt will be on. So people will be like.

You know, he's so anti-technology and he doesn't know and it brought people together. Great, great, great, great. But I was just thinking, you know, what I like about our show is we have Reid Hoffman on. He's a techno optimist. Yeah. You get to hear the full sales pitch for why technology is great. And then we have Jonathan Haidt on it, and you get to hear the full sales pitch on why it's bad.

And instead of being like angry at these guests who have a different point of view, I would really wish people would be grateful that they got to hear the counterpoint to what they believe. I mean, that's. That's what I so enjoy about the show. Yeah. And guess what? I don't know which one I think. Yeah. It's like I half believe what Reed's saying and I half believe what Jonathan's saying. I don't agree with Jonathan. Yeah. But I'm...

so grateful to hear a very smart person tell me the opposite point of view that I have. And I just wish people could click into like, yeah, that's a gift to hear someone with a different point of view tell you what the opposite side thinks. It's not... Shut that person down and get them out of here. And I don't like what they're saying. Yeah, I agree. Now, if we only had one sides of all these debates, I think that would be a pretty reasonable criticism. Yeah, I agree. Yeah.

I was burning a hole in my—go ahead. You know what I'm going to say. Yeah, I want to hear it. It might sound disrespectful to the audience, what I'm about to say. Yeah. And I don't mean that. I love— our audience so much. I love the arm cherries. I'm so grateful that people listen to us, but I don't care. Right. That's healthy. If they don't like.

an episode. I also personally, I don't believe it. I don't believe that what you're reading is indicative of what people think. And that it bums me out that you get. you get like ensnared. Well, some woman told me, I need to apologize for saying young men are disenfranchised. And I said, apologize to who? Like, who am I apologizing to? I know, but this is the... I know. I know. It's really tricky. Now.

I'd say the good news is like, I'm not going to change at all what I'm doing. Yeah. So it's not like I'm subject to altering how I'm going to invite Jonathan on and invite Reid Hoffman on. It's going to have no impact on how I do the show. Um, I think I have a, um, I do have maybe an arrogant delusional belief. I could explain the value of hearing this and people might lock into it and go like, oh, you know what?

I'm gonna stop blasting everyone I disagree with. It's okay to disagree with people. You don't have to hate them. Jonathan's a great guy. I totally disagree with a lot of what he's saying. So I have this stupid belief I can... Encourage people to embrace this. And that's my own delusion. It's a delusion, but you're only seeing like one piece of the whole puzzle. You're so right. You don't know who you're even talking to.

No, you're absolutely right. And I do think about that. So, like, naturally, you're a nice debate about men and women. Obviously. Yeah, yeah. It was very polarizing. I expected that, and that's totally fine. Yeah. And I get it. I get it from both. I totally understand from both sides. But yeah, it's like 50 people.

You know, on either side, out of millions of people. It could literally be one person. This is what I'm saying. Oh, that's got 30 accounts. Yes, this is my point. Like, to get wrapped up in it, you're... strongest trigger is getting taken advantage of. But when you react like this, I think you've been taken advantage of. Because I got wound up about it. You don't even know. But what's perfect about it is it is a facet. of this thing I obsess about without the comments. Yeah. Right, so I...

Your big concern is women's reproductive rights, which makes total sense. It's a concern, yeah. Yeah, but it's like a very paramount concern, and rightly so. Yeah. And you'll think about that a lot, you know? If it feels threatened. I don't think about it on a regular basis. Oh, okay. But if it's threatened, yes, of course. And I'm regularly so scared about the inability for people to listen to one another. Yeah. Like, think about it too much.

And it really frustrates me and it scares me. I'm scared of the future where there's two camps on the planet and they don't talk to each other. Can we deep dive? Yeah. Why is that so scary to you? Like, of course, it sounds it's bad, right? Like, I think it's bad, too. I'm like, this is a huge problem. But I don't have this reaction that you have. And I wonder.

I mean, obviously we know that if anything's like causing that much of a reaction, it's something else. It's something about us or our past or our, like the fear is about us. Yeah, I guess probably dysfunction. I grew up in dysfunction. I grew up in two parents that hated each other till they got divorced, like dysfunction. Yeah. Not rising to one's best self to navigate these things. We have gotten.

embarrassingly dysfunctional. And I see the total root of the dysfunction is us against them. And I see that as such a toxic quality. I have children that are entering a world and I care about the world for them. So, yeah, it really bothers me really deeply. Because my childhood was plagued by dysfunction and two people not communicating, and it's winner takes all. And I hate that situation. It wasn't compromise. It wasn't working together, too. It was, you know, as I always say.

The paradigm everyone needs to wrap their head around is we're married. The left and the right are married. We all live in the same country. And so we have a Gottman approach through this marriage or we have a fucking, what's the famous War of the Roses version of this marriage. And I lived through the War of the Roses versions of the marriages. And so for me.

For me, I didn't want that in my life when I grew up. And then when I feel ensconced in a whole society that's the way, and then I put out a show and I see people. saying, you know, heights of conservative, like they've just written him off. I think I've said this before, but it's like one time we went out to, and this is a ding, ding, ding, because it came up on an episode yesterday we recorded, but Ted Olson, you know, this...

He was the most successful Supreme Court. He argued in front of the Supreme Court more times and more successfully than anyone else. And he very confusingly, from my perspective, both won Citizens United. Which is a very right cause, giving businesses personhood. But he also defeated DOMA. And he believed in both of those deeply. We had a dinner with him. And there was three of us liberals and then him. And... We started kind of hitting them.

him with all of our points of view. And I said, hold on a second. We have an opportunity to be with one of the smartest people in the world who has a different point of view from us. Yeah. What an opportunity to hear the best version of this point of view that I disagree with. If you want to look at.

at it in a way that's selfish, it's good to hear the other person's point of view so that you know how to combat it. Well, you'll find if you combat it, some of their pushback will make some of your points fall flat. And those are points you need to rethink or jettison or figure out another way. But as much as you can learn from them, you also learn the weaknesses of your own point of view.

Yeah. Which I like. I'm arguing with people all the time and I get to one and I'm like, yeah, it's not a good point. I got to get rid of that. And that can't really be a part of my. I also think you are in a program that requires. self-reflection, growth, checking yourself. And so... I do think you're extra hurt. I'm extra. No, no, no. It bothers you more when you see people who aren't doing that or don't care to do it. But there's just a lot of people who don't.

I guess I respect that that bothers you. To me, I think if that bothered me, I would die. Like, that'd be too much. Like, I can't take on that people don't want to. That's not my job to make people want to change. And, you know, like I can only do me. I just wish everyone thought I have I'm holding all my beliefs in my hand right now.

And they're certainly not the best version of my beliefs. They're going to evolve. Hopefully. That's what they're supposed to do. Yes. So you don't have the complete finished version of your beliefs and your points of view. in your hand. People really have a huge problem with wishy-washy.

Right. I've heard that a lot. Flip-flopping. Flip-flopping and a lot about politicians. They say that a lot about politicians that, oh, they said this and now they're saying this. If you catch them having changed their opinion. Right. I find that so strange. Yeah, it's really disappointing. They should be changing their opinion. It's so weird to me. It's so much worse to me that they would have said something so long ago, felt stuck.

In saying that, and now they just have to believe that forever. That's a big problem. But both sides hate that. Yes. Which I really do not. Yeah. Understand. Yeah, yeah, yeah. It feels very backwards. But again, like, I can't get that riled up about other people feeling that way because— I can't change them. But I think you're right. I think this whole thing feels like dysfunctional family to me. Yeah. And I hate it. Yeah.

And I want everyone to be a bigger version of themselves, myself included. Yeah. And it's disheartening to live in a dysfunctional family, which is this country. Yeah, yeah, yeah, yeah. Do you think it's because when your dysfunctional family... ended in, I mean, it ended in pain for you specifically and pain for your mom and pain. All involved. Pain for all involved. The stepdads were miserable afterwards. Their children were miserable.

Because I think every—not everyone, I'm sure some people are spared this, but there's a fair amount of dysfunction that happens in a lot of families. And I think I also grew up with— Some dysfunction. Dysfunction. amongst the adults, but they didn't split up over it. Obviously for me, having grown up and seeing things I didn't like, I think, well, I can't do that. Like for my life that I don't want to replicate that.

But I also am kind of like, like it sort of worked out and it's kind of fine. And if I were you, I might want to challenge me by saying. Maybe everyone's happy with this, which is also possible, you know? Maybe right now the right's super pumped and they're pigs and shit. And the left is vindicated and validated and feeling even more self-righteous. Maybe everyone's getting exactly what they want out of this.

And so that's an interesting thing for me to consider. Like, you're trying to fix something that people will like. That's true. As much as they might not want to say they like this, maybe they do. Yeah. Maybe the person that's like, Jonathan Heights, a monster, felt awesome. Yeah. And told nine of their friends they did that and they love it. Yeah. It's hard for me to.

I also think people, I mean, again, the generous offering is that they want their opinion to be heard and seen. And they want to feel, people just want to feel like a person who's... who exists. I mean, we all just want proof that we exist. Yeah, yeah, yeah. And that is a version of it. I will watch them exist and validate them without that approach. They don't need that approach. Yeah.

But I know I sound like, and that's why I said I didn't want to say anything. If I were not to be like, just, hey, shut the fuck up about the counters. Just stop reading. I fully get that criticism. And it's true. It is true. But yes, it is a perfect little encapsulation of this other thing I spend too much time obsessing about. And if I were really working my AA program, I would just accept this. Yeah.

I would accept that that's how it is. There's nothing you can do. And if someone's attracted to my approach, that'll be appealing to them. Exactly. More so than me. Saying someone should have this approach. Yes, I agree. And I should just have faith in that. Yeah. Yeah. Well, it's funny that you brought up hating because on my ride here. I was listening to a podcast and they were talking about...

Meghan Markle and they were they weren't saying that they hated her but they were saying like there is this like vitriol around her and there is and it was it was interesting because it did make me think People really dined out on her show. Oh, yeah. But people, like, really hate strangers. Like, to me, that is so... interesting and then i was thinking i was like who do i hate well i think we're hardwired to do it right we're hardwired

To extremely punish someone who has values and morals outside of our in-group. And make a emblem of them, right? So I do think when someone... Represent some, you know. Yeah. I don't even know how they articulate why they hate her, but. Yeah. She's interesting, though. I have a story about this, but I want you to expound more. No, I was just going to ask if you hated anyone. When May 1st, when you were going to ask if I hate her.

hated anyone. Oh. Because I was like, I don't, when I really think about it, I mean, I don't hate any strangers and even people in my life who I, like, who I do have, like, friction or cause stress. Yeah. I don't hate them. I don't think I hate anyone, actually. I hate a couple people in public. I hate Tucker Carlson. Right. I just think he's a smug bully. I don't even really give a fuck about his politics. Is this the smug bulliness about it? Yeah. Is there anyone else?

Like I'm trying to imagine, and if you're saying you hate them, you have to take it to the, like literally you hate them to the degree if you saw them in person, you'd go, you're a fucking asshole. Yeah, yeah. And so I think the only person I can think of him that if I met him real life, I'd go, you're a fucking. piece of shit would be him. Yeah, I feel like I remember one time years and years and years ago, probably when I was babysitting and we were playing games and stuff, Catan.

I said something like, oh, I hate this. And you said, you say hate a lot. Uh-huh. We've talked about this before. Well, it's been a minute probably. I was saying it just as a random word. As an adjective. Yeah, it didn't carry the weight that it was carrying for you. But then I was like, yeah, that is. a big word to be sort of throwing around. And I think I don't really say it as much. No, not at all. Yeah. Yeah. I think I used to say it too. I think that's one of the aspects of my...

point of view shifting of moving to California that I liked a lot. Yeah. I think when I was in Michigan, I had a very long list of enemies. You know, people we hated. Right. A lot of people we were against. Interesting. Wait, back to. Okay, back to Meghan Markle. Yeah. So I saw, I didn't even see it, but I saw some of the Oprah thing. Their very first interview, right? And a friend of mine from England.

Like, let it rip on her. Like, can you fucking believe this? Like, just outrage, right? And so, and this friend, I really respect. their intelligence, their empathy, the whole thing. This person's a very admirable person. Yes, I agree. And so I had to really force myself to imagine, how could he have this strong of a reaction? Yeah.

And the scenario I painted in my head was, and I think I've already told you this, when Obama was in office, a Russian kid comes to the D.C., falls in love with Malia. takes her to Moscow. He and her go on their biggest television show and shit all over Obama and accuse him of being racist and just trash the country. under the guise of this Russian dude. And I was like, yeah, I would fucking hate that guy. I would absolutely hate him.

And there's a layer of patriotism that has to be acknowledged that we all carry. And if I do think of that scenario. I just know I would hate the Russian guy who took Malia to Russia for the rest of her life and they go on TV all the time and shit on America. I would hate that guy. I don't understand the Americans who hate her so much, but I do understand the British backlash. They took... The prize son. They all liked him more than the other one. Right. But he... Taking is so, like...

Like he didn't have a mind of his own. Oh, I know. I mean, that's so. But then I'd be saying Malia doesn't have a mind of her own. But if Malia left with this Russian dude. Made the choice. Never to return. I mean, yeah. And then went on Russian television and shit on America. What?

I'd hate the whole scenario. I guess, I don't know. I don't know that I would. I think I would be like, yikes. She like, she had a bad experience. You gotta evaluate him. You gotta evaluate the dude. That's the part I actually can't relate to. Like for me. Harry made a choice about his life and his family. And I don't see it as this woman like took him away. A siren who called him to the rocks of America. Exactly. I see it as a man who made a choice based on.

a lot of things, including the death of his mother. And so I don't... have a problem with him being like, there's a lot of fucked up shit over there and I had to leave it. But I think we have clarity on that one because we don't have the in-group. patriotic bias. True. But I think if Malia left and married this Russian person and then they went on Russian TV and they were talking about it and she was saying like, look.

The White House was horrible. And the media in America was horrible. And this is what they did. And this is what happened. But really quick. So I'm not talking about Harry and Meghan. Right. I'm talking about this theoretical Malia. Yeah, I know. Yeah, yeah. I would go, oh, you hate the media?

You're on the biggest fucking show in Russia. You can't hate the media and then willingly participate in their biggest media outlet. Well, they hate the media. You're such a fucking hypocrite. Well, no. That's what I would say to this imaginary. people who's on the biggest media outlet in Russia complaining about media attention. But I'm saying they speak specifically about British media. Yes. And we have had enough people on who have corroborated.

that the British- I want to be clear. I understand why. I am not, none of this opinion is about those two. No, I know, I know. But I do have strong knee jerks about this theoretical defecting of Malia to Russia and being on TV completely. about being on TV. I guess I don't. I just don't. Like, I think if they were like, because we have to make it equal. I don't because I don't. I mean, look, we have obviously media issues, but it's not the same. Well, let's just say it's.

The scenario I painted is actually less impactful than the one that really happened because Malia was never going to inherit the presidency. Yeah. Harry could inherit the kingship. No. Yeah, his brother would have to die. No, then it goes to the son. William's son. Harry can't be the king. Okay, when the son dies. He could be the king. Okay. There's a long list? Yeah. Okay. Would they give the kingship to a seven-year-old? I don't think...

Yeah, like Joffrey. I want to do a little digging on this. Joffrey. There's no inheritance in the presidency. So the scenario I'm painting is even less impactful. I agree. I mean, that's why we don't, it's like hard to make this equivalency, but. But also, like, why should he possibly stay in this thing that he sees is fucked up? Oh, yeah, yeah. Like, I don't know. I just commend. But an outsider came in.

And then the beloved person left. And that's easy correlation to get upset about. I mean, look, I. Maybe Harry would have defected on his own without a wife that was American. That's possible. Yeah. But we don't really know because it didn't happen that way. But we also, we also, you know, more than anyone that like if someone, if you're in love.

with someone and people around you are not treating that person well. Yeah, you got to protect them. You're going to protect them. And you're going to say, ultimately say, fuck this. Like, this is a problem. We're going to go now. Yes, but so I already agree. I understand why he left and I would have left. Yeah.

A thousand percent. You're just saying you understand why people don't like it. I totally understand why people don't like her that are English. Right. It's not hard for me to understand. It's not hard for me to understand. I do wish they would take a second look at it. Like, it doesn't affect them. It really doesn't. Well, they lost their cutest royal family member. Get over it. Like, I mean. And I hate royalty. Yeah. But I understand something you value getting.

quote, taken from you. I don't even say taken. I understand losing something you value. So it's like they do value that. I can't understand it. No, sure. The notion of like royalty. I actually can understand that weirdly. Right, you like royalty. I can buy into the royal family and thinking that's cool and that's a part of your history. I do get that.

Even that, like, even feeling that way, I don't think I would feel personally injured by one of them going to live their life. I think differently. I think people. don't like her because they think she's fake. People think she's fake. People think she's mean, but she pretends to be nice. There's a lot of...

And then with the new show, they're like, what is this? She's just moving pretzels from one bag to another bag. This is stupid. I don't know that reference, but I'm laughing right now because the description was really funny. I just, Megan, Marco, I didn't see that, so I'm not laughing at it. You know what? I'm not laughing either because it's clear that she does like it.

I don't think it's fake. It may seem ridiculous to someone who's like living a life, going to work and having to come home and then turning that on. Living paycheck to paycheck. Exactly. Turning it on and seeing that her day is spent moving pretzels from one bag into another bag. Well, now I really want to watch this episode. It's like that's a very – Simple.

Simple explanation. She's having a guest over and she's gonna put together this like cute little tray by the bed for the guest. Yeah. It has like flowers and stuff and then she like... buys these pretzels, I think with peanut butter, they look delicious. Okay. And— And she put them in another—she took them out of the bag. She put them in another cute little bag and put, like— So you've watched it. Yeah. Oh, yeah. Yeah, yeah. Yeah. And put them, like, you know, wrote—

prepped peanut butter pretzels and like tied it up. Made it cute. She made it cute. And I think that does bring her joy. Yeah, sure. I don't think that's a lie. Right. And so. It's kind of what we talked about before with the, you know. podcasts, the like men's podcasts and stuff. Yeah. If you don't like it, just don't watch it. If you think this is sort of offensive because your life, it's not reflective of your life.

Stay tuned for more Armchair Expert, if you dare. I'm John Robbins, and joining me on How Do You Coke this week is the fitness coach, cookbook writer, and social media personality, Joe Wicks. There was something about physical exercise and, yeah, I suppose pushing myself physically meant that I didn't need to talk about what was going on at home. There was this fear around, could I talk about my mum and dad's addiction and mental health issues because I thought I'd be taken away.

So that's How Do You Cope, with me, John Robbins. Find us wherever you get your podcasts. I bet the core thing that people are triggered by is like, why does this woman get a show about... the thing she likes. Yes. Why don't I have, like, why would I actually build birdhouses? Right, right, right, right. I actually do X, Y, or Z. Yeah. And I do think. It's easy to think in some abstract way, she got something that you deserved more. Right. As if her thing took from you.

Yeah. And that in general, people who don't deserve things are taking opportunities. Yeah. That should go to deserving people. Right. Yeah. Can I quickly get into some very large. moral imperative stuff. Well, yes, because who deserves anything? Like we do we inherit? I mean, we deserve like dignity. Uh-huh. But to me, other than that. We as people don't like come out deserving of money or I don't know. It's a weird thing. I'm yes and no. Yeah.

Yes and no. There's like a nihilist version of me that I can tap into pretty easily, which is like, who's kidding who? We're all staying busy on this circular globe until we die. Yeah. There's no God. There's no one who's evaluating what should and shouldn't. and better and worse. Like we're just all distracting ourselves in the most entertaining fashion we can manage until we're dead. Yeah. So there's that version. It's like, yeah, what are you talking about? You don't deserve, you deserve.

For 300,000 years, you deserve to come out without clothes on and be ill-equipped for this world. In the best case scenario, you ate and had a kid. So the notion that at some point a TV show was a human right. Or a cell phone's a human right. Or I hate to say it, that healthcare is a human right. These are all really, really incredible modern privileges. Yeah, they're advanced privileges, yes. Okay. And now also on the other side, yes, Brene Brown deserves a podcast more than a lot of people.

Because she has spent a good chunk of her life acquiring knowledge that is useful to other people. And yes, she does. I would have to be lying to say that the guy in front of 7-Eleven, who's repeating the same sentence over and over again, should have the same...

level of success on a podcast that Brene Brown has. I can acknowledge some people do deserve the success more than others because they've put more effort into it and they have more dedication and they have more skill. Jordan deserves his six. titles more than a lot of the players. It's not like everyone who entered the NBA deserves six titles. I just mean we don't all deserve to.

be a basketball, I mean, like, that's my whole point. We don't come out deserving everything. We have different skills and privileges and things that allow us to, like, live the life we're going to live. But I don't know that we deserve... I don't know that Brene... I mean, of course, I love her, so I think she deserves... Yeah, we're biased. Yeah. But the 7-Eleven guy, if...

If his one sentence repeated over and over again. If his one sentence repeated over and over and over again has a massive impact on people. Yeah. And it changes their life and it like makes them think about the world differently. He deserves it. absolutely but what I think is even more interesting is so I feel that way about that topic but what I can admit and acknowledge is there's another scenario you could paint that is the same principle at hand

And I'll go the other way. Yeah. I think that's what's much more fascinating and more fun to pay attention to is this illusion that I have a consistent policy. Yeah, exactly. And I don't. Yeah, none of us do. And what really happens is I look at the person and generally I like them or I don't like them on some weird gut level. And I'm generally accepting of the things that people do that I like. And I'm critical of the things from people I don't like. Yes. And I frame it under this.

well-thought-out logic I have. And it's just so inconsistent that I have to acknowledge there's a lot going on. I do think so much of dislike, though, is jealousy. Oh, yeah. In general and for all of us, if we dislike a lot, not always. Of course, there's like people who do horrible shit to other people. Yeah. You're going to dislike that. But like.

When you're just like irked by someone who you don't know. Yeah. It's probably because there's something that you're triggered that you wish you had. I mean, again, this thing she's presenting is... perfection right like she has she's able to make her own honey she has this bee farm she has her own bees yeah she has her own bees and she makes her own honey and then she makes these like have I told you bees have rebounded really yeah

Really? It's like great news. Remember that panic we were all in? Yeah. They've totally rebounded. Because of her. Perhaps. Oh, my God. So we all heard that accredited. Wow. That is good news. Yeah. But like she makes her own like. raspberry preserves and like, cause she has a raspberry bush. And so people are like, I want a raspberry bush and I want to spend my day doing this nice fun stuff. Exactly. Well, there's probably that. And then there's also Martha Stewart.

Yeah. There's Martha Stewart who has spent her entire life really becoming a master at all these things. And then she has a show, and by God, it's very, very helpful and useful to people because she's a master. Yes. And so if you're comparing these two people and they both have a similar size show, I can understand people being a little frustrated. Right. It would appear that one person really is now benefiting from their dedication and love.

For their whole life. Yeah. To something. That's a good story. Yeah, yeah, yeah, yeah, yeah. Versus like, and I could do this. I'm not a good woodworker. But I bet your ass I could sell a show to Netflix tomorrow about me with a wood shop building things. Yeah.

And if I was a master woodworker, I'd be like, this is bullshit. Why is it? And that would be fair. And also, if I want to do a show about woodworking and I think it's fun and people are interested in it, why can't I do that? Exactly. So I think. All these things are true. So Kristen came home to me and she said, oh my God, I got like five texts from people. Like I could, they were salivating to share this news about Meghan Markle's show.

And she started calling people out. Yeah. It seemed a little too excited about what you determined was a failed attempt by somebody. If you're taking a lot of joy out of a failed attempt on somebody. Is that who you want to be? Yeah. Bigger question. Exactly. And I also think it's worth delineating because I'm critical, as you know. I'm trying to shut the fuck up about it, but I am critical of people that are allowing someone to make them miserable.

As I've said, right? Circles back to what I said earlier. It's like 2016 to now. If you've been miserable for nine years or an hour of your day is spent in anger, I just think that's a rough use of your life. Now, if you're seeing the thing, the Megan thing, and you're excited and you share it with your friends and you all gossip and you all have a good time doing that at dinner, I guess I'm not critical of that.

In a weird way. I feel bad for the subject of the ridicule, but I also can just, again, in a utilitarian way, look at, oh, these five people had a really fun dinner for two hours gossiping, which is a... which is an adaptation of social primates. Like we're wired to do it. Yeah. I guess I also can go, yeah, okay. You guys had fun shitting on somebody.

Everyone felt better for some reason about themselves. I mean, that's the part. That's a bummer. Yeah. But if, if the end result was you all did that versus you all got together and you like this motherfucker and I can't believe this. Yes. Outrage. And, and. Feeling defeated and overwhelmed and all that. I weirdly have a distinction between those two things. Yeah, one's harmless and the other one is causing harm. Personal harm to them, the people who are doing it. And I mean, I do think it's...

It's a privilege to be Kristen or be me. And I'm like watching this, you know, I'm just watching the show and I'm like, oh, yeah, like. I want that bag. Yeah. I'm like, oh, my God. Like, I should order some of those tomatoes and make that. Because you're not frustrated with the outcome of your life. Exactly. I am not like, well, why does she get to have that? You have funny.

I have plenty. That's right. That's right. I have more than I should have. That's right. And I do too. And I'm not as bothered by a lot of things that people are bothered by. And I know it's a privilege. What is so tempting to try to tell people is it is a product of your own. You think this person's objectively one thing. Yeah, I know. And it's helpful to understand, no, if my cup was full.

Actually, and shockingly, I wouldn't feel the same way. I know. And you kind of want people to know that because I think it is helpful for development, which is like. My opinions of things are dramatically impacted by how I feel about my own self and my own outcome. And I would probably be best served trying to love. This version of myself enough that I don't feel anger when other people are doing well. Real quick facts. This is for Mary Claire Haver. Great episode.

Solid. My assumption is it's hopefully going to be huge. Get that topical vaginal cream, everybody. Go out right now and just start smearing it all over. She already posted about it. She did? Uh-huh. It was really sweet and cute because it was out early. And she said it was really, she had a good time with us. Can I Easter egg that? I got the text of my life last night that I shared with you guys. Yeah.

We can't say anything else. I urge people to hang on to the show a little longer. I know a lot of people are thinking about quitting, but just hang out for a couple more months. Wow, wow, wow. Wow. I'm gonna have to get a facial. Hard as a rock. I'm gonna have to. I'm gonna have to jerk off before the interview so I can last during the interview. Yeah, same. Yeah.

You don't have to wear really strong pants, not ones that can explode. You're going to have to be in fucking steel trousers. Might want to go short skirt. I say you go all the way. If ever there was a time to take the biggest shot of your life, you might want to go skirt. Bra top. Braless see-through top. I do have a new top that is pretty see-through. Oh, my God. And this person's a fashion icon, so they would just be like, oh, yeah, fashion.

I could maybe get away with it. I think you should go. You'd have to blur it, Rob. Oh, they could. Yeah, that could be done. On YouTube. Yeah, no problem. For him. For him. Or her. Or her. Whoever our guest is. Wow. I can't wait for it. That's an even more fun element to think about. is coming. How I'm going to show up. Yes. Yes. And how aggressive you'll be. And I just want you to know that I am encouraging you to go above and beyond the realm of what you think is tasteful.

And you'll be sitting directly across from this person? Yeah, but you know my instinct is to just like play it so cool. Can you cross your legs a lot? No, go for it. I know. I don't know though. On your deathbed? On your deathbed. I think this person might. be more intrigued by someone playing it so cool? I don't think so. Let me just, let me give you some inside baseball, guys. Yeah. There is no guy who's going to see

a rockin' bod on display and think, mm, not for me. I mean, there'll be no straight guy who thinks that. Yeah, Jess says he's starting to turn. The Maury hangs out with me. Oh, my God. So you guys might end up. Might end up together after all. What a great time. And then you guys bring back Monty and Jess love boys, but it's like Monty and Jess are married. That would be boring. Well, no, you'd be fighting.

All this fun you're having would quickly turn to fighting, so that could be entertaining. Oh, man. Anyway, okay, well, that's TBD for people. Yeah, that's exciting. Okay, some facts. Okay, Rob, can you help me? What did you type in to get the names of those guys who did the WIH study? I looked at Dax's notes for the episode and saw what he wrote down.

That is, I, for the life, I was trying so many ways of typing this into Google and I can't, it's, that's not coming up for me. Yeah. Do you want me to spell it for you? Yeah, let me find it again. Sploblowski and Travowski. C-H-L-E-B-O-W-S-K-I. Chlebowski. And A-R-A-G. A-S-K-I. Okay, so these are for the Women's Health Initiative. This is who you say was a part of the study, and this is who— I could be conflating. I just want to be clear. The stuff I was saying that— Both Atiyah and Lane Norton.

Are all over. Yeah. Is Chlebowski and Eras. Okay. They're the ones that keep doubling down on this bad data. Okay. So maybe they've doubled down. But they, I don't think, are part of the original study. Okay. Dr. Bernadine Healy. This is in 91. She was the female director of the NIH, and she announced her plan for the Women's Health Initiative. There was a ton of people involved in this. And it was a 15-year study.

I mean, and it was wrong. Yeah. Not right. It was not right. And led to a mass panic. Okay. Now, peak suicide rates for women. Female suicide is concentrated in the 35 to 64 year age group. That's 64.8%. I don't know why that's so weird for me. I mean. I get it. I get why it's weird. I wouldn't have expected that either. It's weird, but obviously we were just given the explanation, which is menopause. But it is, it's just not the time. You think that's the time of your life you start fully.

Accepting who you are and what reality is and start transitioning. Yeah. But it's those hormones. Brain changes. Scary. But good to know. Like if you're starting to feel. Yeah, that know when you're in the danger zone? Yeah, exactly. Higher to the danger zone. Okay, now male pattern baldness. MPB. Did I say one thing? Yep.

I was eating at a restaurant this morning with Nate. He left. I paid. Woman came over to the counter or to my table. And she said, I just want to thank you for the Blaze episode. I have BPD. Oh my gosh. And I think that episode probably saved me like two years of my... trajectory to dealing with this great so she realized she had it because no i think she already knew but she hearing from him something he did you know she's like it just kind of like fast forwarded her two years in the process

And it was very good for me to meet her. Because I think a lot of times you're like, BPD, they fuck up the person's life who loves them. And you villainize them. And it was very helpful to look at this young woman who's so grateful for help for this thing she doesn't want. Yeah, I was very happy to. That's lovely. Yes.

Yeah, I like that. So fucking good luck, BPD survivors. Yeah. Yeah. Wow, it's the first time you've ever said survivors. You don't say survivors. I don't like that term. I know. Yeah. Just like the most PC you've ever been. Yes, yes, yes, yes. Yes, yes, yes. Okay. Okay.

Male pattern baldness doesn't exclusively come from the mother's side. It can be influenced by genes from both parents. The AR gene is located on the X chromosome, which men inherit from their mothers. However, other genes and environmental factors also play a role. If your mother's father has male pattern baldness, you're more likely to have it too. If your father is bald, you're twice as likely to have it. Hormonal fluctuations...

Fluctuations, nutritional habits, stress level, and lifestyle choices can impact the onset and progression of baldness. Yeah. Genetic factors from both parents significantly influence the likelihood. I'm fighting for my life. You're doing fine. I think I'm doing fine in the battle, but I'm fighting with all I got. Oh, I see. I see. It's morning and night, that fucking topical that I hate. I hate how it makes my hair feel.

Yeah. I got to hold my head back so it drips back. It's embarrassing to see me at night in the mirror dealing with trying to keep my hair. Do you want to do that thing that Ike did? What did he do? The PRP. Oh, I don't believe in it. Oh, okay. What I really want more than anything is for them to figure out how to clone hair. And I want to go in and get my hair cloned and have massive surgery. Oh. And get the thickest lion mane head of hair and have long braided hair. Oh, my God. Like a Viking.

Oh, wow. Maybe I'll be in my Viking outfit for our guests and you'll be in your outfit. And we'll let the chips fall where they may. Maybe I'll be wearing a kilt and I'll be in a kilt crossing and uncrossing my legs repeatedly. Okay. Yes. Oh, we're going to be competing. Oh, this is great. So in 1970, we're doing the river dance. I know, this poor guest. Oh, my God. Okay. And then, oh, real quick. So she said that there are places that you can donate your eggs for free and keep some. Yeah.

So that's cool. And there's one place called Co-Fertility that does this. I don't know if this is the one she was talking about. I can't endorse this. I don't know much about it, but it is one of the places. It is something that came up in a Google search. Yes. If you'd like to look into it. That's a place. All right. That's it for Mary Claire. Thank God she came in. She really rattled me. I'm going to use another word I don't like. Say it. I'm on a roll. She's a rock star.

You don't like that? No. I feel like you say it. Oh, no. Oh. Yeah, sorry. The list is long. It's hard to keep track of all the things. Atelier, artisanal, rock star. Oh, my God. Atelier. This past weekend. Cock. I hate the word cock. Oh. That's a thing that like aggro dudes use to try to emasculate other men. They call them a cuck. Because a cuckold? Yeah. Oh, weird. Yeah. Last weekend, I was...

Doing a long walk. I walked on sunset. I was doing this whole thing. And I passed a new coffee shop. And I went in and I tried it. And I texted Rob and I asked if he had tried it yet. And then he went the next day. and he reminded me there was a merch there that said Atelier on it.

Did you buy it? No, I almost did. Yeah. To put in here. Yeah, I know. I considered it too. Should we get it? Should we have a t-shirt that says Armchair Atelier? I've been saying that. Yeah, I was just repeating what you said. Just doubling down on what a great idea that you had. I've been saying that. Hey, hey. Okay, love you. All right, love you. Follow Armchair Expert on the Wondery app, Amazon Music or wherever you get your podcasts.

You can listen to every episode of Armchair Expert early and ad-free right now by joining Wondery Plus in the Wondery app or on Apple Podcasts. Before you go, tell us about yourself by completing a short survey at wondery.com slash survey. I'm Indira Varma, and in the latest season of The Spy Who, we open the file on the spies who invaded suburbia. The illegals weren't just blending in. They were the embodiment of the American dream.

Nine to five jobs, dropping the kids off at soccer practice, and just the right amount of charm to slide into the orbits of the powerful. But behind closed doors, they were Russian operatives, meticulously crafting coded messages and feeding Moscow everything it needed to stay one step ahead of the US.

When a powerful mole reveals the names and locations of the undercover spies, the FBI finds itself walking a tightrope, protect its most crucial informant, whilst avoiding a catastrophic diplomatic firestorm. Follow the Spy Who on the Wondery app or wherever you listen to podcasts. Or you can binge the full season of The Spies Who Invaded Suburbia early and ad-free with Wondery+.